Megalin-based delivery of therapeutic compounds to the brain and other tissues

ABSTRACT

The present invention is directed to a methods and compositions for receptor mediated drug delivery, particularly across the blood-brain barrier.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 10/600,862, filed on Jun. 20, 2003. The contents of this priorU.S. application and all other U.S. patents cited herein are each herebyincorporated by reference in their entirety.

BACKGROUND

1. Field of the Invention

The present invention is generally directed to compositions for andmethods for achieving the delivery of therapeutic and/ordiagnostic/investigational agents.

2. Background of the Related Art

The brain is shielded against potentially harmful substances by theblood-brain barrier (BBB). The microvascular barrier between blood andbrain is made up of a capillary endothelial layer surrounded by abasement membrane and tightly associated accessory cells (pericytes,astrocytes). The brain capillary endothelium is much less permeable tolow-molecular weight solutes than other capillary endothelia due to anapical band of tight association between the membranes of adjoiningcells, referred to as tight junctions. In addition to diminished passivediffusion, brain capillary endothelia also exhibit less fluid-phasepinocytosis than other endothelial cells. Brain capillaries possess fewfenestrae and few endocytic vesicles, compared to the capillaries ofother organs (see Pardridge, J. Neurovirol. 5: 556-569, 1999). There islittle transit across the BBB of large, hydrophilic molecules aside fromsome specific proteins such as transferrin, lactoferrin and low-densitylipoproteins, which are taken up by receptor-mediated endocytosis (seePardridge, J. Neurovirol. 5: 556-569, 1999); Tsuji and Tamai, Adv. DrugDeliv. Rev. 36: 277-290 (1999); Kusuhara and Sugiyama, Drug Discov.Today 6:150-156 (2001); Dehouck et al. J. Cell. Biol. 138: 877-889(1997); Fillebeen et al. J. Biol. Chem. 274: 7011-7017, 1999).

The blood-brain barrier (BBB) also impedes access of beneficial activeagents (e.g., therapeutic drugs and diagnostic agents) to centralnervous system (CNS) tissues, necessitating the use of carriers fortheir transit. Blood-brain barrier permeability is frequently arate-limiting factor for the penetration of drugs or peptides into theCNS (see Pardridge, J. Neurovirol. 5: 556-569, 1999); Bickel et al.,Adv. Drug Deliv. Rev. 46: 247-279, 2001). For example, management of theneurological manifestations of lysosomal storage diseases (LSDs) issignificantly impeded by the inability of therapeutic enzymes to gainaccess to brain cell lysosomes. LSDs are characterized by the absence orreduced activity of specific enzymes within cellular lysosomes,resulting in the accumulation of undegraded “storage material” withinthe intracellular lysosome, swelling and malfunction of the lysosomes,and ultimately cellular and tissue damage. Intravenous enzymereplacement therapy (ERT) is beneficial for LSDs (e.g. MPS I, MPS II).However, the BBB blocks the free transfer of many agents from blood tobrain, and LSDs that present with significant neurological sequelae(e.g. MPS III, MLD, and GM1) are not expected to be as responsive tointravenous ERT. For such diseases, a method of delivering thereplacement enzyme across the BBB and into the lysosomes of the affectedcells would be highly desirable.

Three ways of circumventing the BBB to enhance brain delivery of anadministered active agent include direct intra-cranial injection,transient permeabilization of the BBB, and modification of the activeagent to alter tissue distribution. Direct injection of an active agentinto brain tissue bypasses the vasculature completely, but suffersprimarily from the risk of complications (infection, tissue damage)incurred by intra-cranial injections and poor diffusion of the activeagent from the site of administration. Permeabilization of the BBBentails non-specifically compromising the BBB concomitant with injectionof intravenous active agent and is accomplished through loosening tightjunctions by hyperosmotic shock (e.g. intravenous mannitol). High plasmaosmolarity leads to dehydration of the capillary endothelium withpartial collapse of tight junctions, little selectivity in the types ofblood-borne substances that gain access to the brain under theseconditions, and damage over the course of a life-long regimen oftreatment.

The distribution of an active agent into the brain may also be increasedby transcytosis, the active transport of certain proteins from theluminal space (blood-side) to the abluminal space (brain-side) of theBBB. Transcytosis pathways are distinct from other vesicular trafficwithin the capillary endothelial cell and transit can occur withoutalteration of the transported materials. Transcytosis is a cell-typespecific process mediated by receptors on the BBB endothelial surface.Attachment of an active agent to a transcytosed protein (vector orcarrier) is expected to increase distribution of the active substance tothe brain. In transcytosis, the vector is presumed to have a dominanteffect on the distribution of the joined pair. Vector proteins includeantibodies directed at receptors on the brain capillary endothelium(Pardridge, J. Neurovirol. 5: 556-569, 1999) and ligands to suchreceptors (Fukuta et al., Phamm Res., 11(12):1681-8; 1994; Broadwell etal., Exp Neurol., 142(1):47-65 1996). Antibody vectors are transportedthrough the capillary endothelium by a process of adsorptive endocytosis(non-specific, membrane-phase endocytosis) and are far less efficientlytransported than actual receptor ligands, which cross the BBB by asaturable, energy-dependent mechanism (Broadwell et al., Exp Neurol.,142(1):47-65 1996).

The lipoprotein receptor-related protein (LRP) receptor family comprisesa group of membrane-spanning, endocytic proteins with homology to theLDL receptor. Characterized as playing a key role in lipoproteinmetabolism, LRP have subsequently been shown to bind a variety ofligands present in the blood. (Herz and Strickland, J Clin Invest.,108(6):779-84, 2001). LRP ligands include the lipoprotein-associatedproteins ApoE, ApoJ and lipoprotein lipase; proteinases tPA, uPA, Factor1× and MMP-9; proteinase inhibitors PAI-1, antithrombin III,alpha-2-macroglobulin and alpha-antitrypsin; the antibacterial proteinlactoferrin; the chaperone receptor-associated protein (RAP), thehormone thyrotropin, the cofactor cobalamin and the lysosomal proteinssaposin and sphingolipid activator protein. Four of these ligands, ApoJ(Zlokovic et al., Proc. Nat'l Acad. Sci., USA 93(9):4229-34 1996;Zlokovic, Life Sci., 59(18):1483-97, 1996), thyrotropin (Marino et al.,J. Biol. Chem., 275(10):7125-37 2000; Marino et al., J. Biol. Chem.,274(18):12898-904, 1999), lipoprotein lipase (Obunike et al. J. Biol.Chem., 276(12):8934-41, 2001) and cobalamin (Ramanujam et al., ArchBiochem Biophys., 315(1):8-15, 1994) have been shown to be transcytosedacross capillary endothelial cells in vitro and in vivo by LRP familymembers.

Taken together, the LRP receptor family comprises a pool ofcompositionally and functionally related receptors expressed atdifferent levels in different tissues, including capillary endothelium,neurons and astrocytes. LRP family members are professional endocyticreceptors that have also been shown to transcytose ligands acrosspolarized epithelia.

A unique LRP ligand is the receptor-associated protein, RAP, a 39 kDchaperone localized to the endoplasmic reticulum and Golgi (Bu andSchwartz, Trends Cell. Biol. 8(7):272-6, 1998). RAP binds tightly to LRPin these compartments preventing premature association of the receptorwith co-expressed ligands (Herz and Willnow, Atherosclerosis 118Suppl:S37-41, 1995). RAP serves as an attractive targeting sequence forLRP due to its high affinity for all members of the LRP receptor family(˜2 nM) and ability to out-compete all known LRP ligands. Since RAP isnot secreted, endogenous levels in the blood are low. Endocytosis of RAPby LRP results in localization to the lysosome and complete degradationof the protein. Structure-function studies have been performed on RAP,providing some guidance on minimization of the sequence required tofulfill the targeting function (Melman, et al., J. Biol. Chem. 276(31):29338-46, 2001). It is not known whether RAP is transcytosed, butMegalin-RAP complexes have been shown to remain intact as far as thelate endosome (Czekay et al., Mol. Biol. Cell. 8(3):517-32, 1997). Theintegrity of the Megalin-RAP complex through the Compartment ofUncoupling Ligand from Receptor (CURL) and into this late endosomalcompartment is in contrast to the observed instability of otherLRP-ligand complexes in the early endosome. The LRP-RAP complex thusappears to have enhanced resistance to acid-dependent dissociation, apotential indicator of transcytotic competence. RAP could be engineeredto be more specific for particular members of the LRP family. Suchmodifications would allow more selective targeting of RAP fusions toparticular tissues, as dictated by the expression of different LRPfamily members on those tissues.

Furthermore, RAP may be a suitable substitute for the mannose6-phosphate targeting signal on lysosomal enzymes. The LRP-RAP systemshares many features with the mannose-6-phosphate receptor (MPR)-mannose6-phosphate (M6P) system: Both receptor-ligand complexes, LRP-RAP andMPR-M6P, exhibit dissociation constants in the 1-2 nM range and arestable in the CURL. Both LRP and MPR are widely expressed on a varietyof tissues and efficiently transport bound ligand to the lysosome. Bothtypes of ligands are degraded upon reaching the lysosome. The advantageof RAP targeting over M6P targeting is that it depends on a proteinsequence rather than a modified carbohydrate. Biosynthetic throughputand quality control are much higher for an amino acid sequence than fora modified oligosaccharide, allowing for better drug yield, potency andsafety. The LRP-RAP system may also provide a method of efficientlytargeting other tissues. For example, the high density of the Very LowDensity Lipoprotein Receptor (VLDLR), a member of the LRP family), aswell as LRP1 on muscle cells implies that RAP fusions could be taken upto a significant extent by muscle through LRP receptor-dependentendocytosis (Takahashi et al., Proc. Natl. Acad. Sci. U.S.A.89(19):9252-6, 1992).

However, there remains a need for novel compounds, pharmaceuticalcompositions, and methods of administration of such compounds andcompositions that can more effectively deliver active agents to thebrain and other biological compartments. In particular, there is a needfor such novel compounds, pharmaceutical compositions, and methods ofadministration which deliver active agents to the brain and tissues ororgans that are set off from the blood compartment by capillaryendothelial cells that are closely sealed by tight junctions. Inparticular, there is a need for such novel compounds, pharmaceuticalcompositions, and methods of administration, which efficiently targetthe delivery of an active agent to a wide variety of tissues. Inparticular, there is a need for such novel compounds, pharmaceuticalcompositions, and methods of administration, which target the deliveryof an active agent to the lysosomal compartment of a cell within thosetissues. This invention provides such compounds, pharmaceuticalcompositions and methods for their use.

SUMMARY OF THE INVENTION

The present invention relates to the discovery that megalin ligands canbe used as carriers or vectors for the delivery of active agents viatranscytosis. An exemplary such ligand is RAP, which serves to increasethe transport of therapeutic and/or diagnostic/investigational agentsacross the blood brain barrier and/or deliver agents to lysosomes ofcells within and without the CNS.

In one aspect, the invention provides compounds comprising a megalinligand or a megalin binding fragment of a megalin ligand conjugated to atherapeutic and/or diagnostic/investigational agent and pharmaceuticalcompositions of such compounds. In some embodiments, the megalin ligandor megalin binding fragment of such a ligand may be modified as desiredto enhance its stability or pharmacokinetic properties (e.g., PEGylationof the RAP moiety of the conjugate, mutagenesis of the RAP moiety of theconjugate).

The present application specifically contemplates a compound comprisinga megalin-binding moiety conjugated to an agent of interest. The agenttypically may be selected from the group consisting of a therapeuticagent, a diagnostic agent, a marker of a disease of the central nervoussystem (CNS), a labeled monoclonal antibody which binds a marker of aCNS disorder. Therapeutic agents that are useful in the compoundscontemplated herein include but are not limited to proteins, cytotoxicchemotherapeutic agents, protein nucleic acids, siRNA molecules,antisense molecule, and expression constructs that comprise a nucleicacid that encodes a therapeutic protein of interest. The megalin-bindingmoiety and the agent of interest may be directly linked to each other oralternatively may be linked through a linker, such as e.g., a peptidelinker. Preferably, the megalin-binding moiety is a moiety that istranscytosed in vivo. Exemplary such moieties include but are notlimited to RAP, thyroglobulin, lipoprotein lipase, lactoferrin,apolipoprotein J/clusterin, apolipoprotein B, apolipoprotein E, tissuetype plasminogen activator, uPA, PAI-1, vitamin D-binding protein,vitamin A/retinol-binding protein, β2-microglobin, α1-microglobulin,vitamin B12/cobalamin plasma carrier protein, transcobalamin (TC)-B12,PTH, insulin, EGF, prolactin, albumin, apo H, transthyretin, lysozyme,cytochrome-α,α-amylase, and Ca2+, and aprotinin. The compound mayoptionally exclude ApoJ.

The invention contemplates a chimeric molecule for transcytotic deliveryinto the brain across the blood-brain barrier, the chimeric moleculecomprising a megalin ligand conjugated to an active agent to bedelivered across the blood-brain barrier by transcytosis, wherein themegalin ligand facilitates transport of the chimeric molecule across theblood-brain barrier. Also contemplated is a chimeric molecule fordelivery into the brain by transcytosis across the blood-brain barrier,the chimeric molecule comprising an LRP ligand conjugated to an activeagent to be delivered across the blood-brain barrier by transcytosis,wherein the megalin ligand binds preferentially to megalin as comparedto LRP1. Any of the compounds or chimeric molecules contemplated hereinmay be prepared as pharmaceutical compositions comprising the compoundor chimeric molecule in a pharmaceutically acceptable carrier, diluentor excipient.

In particular embodiments, the agent is a bioactive protein or peptidecovalently linked to the megalin ligand or megalin binding fragmentthereof. Such conjugates or chimeric molecules may be formed bysynthetic chemical reactions or joined by linker groups. In preferredembodiments, when the active agent is a protein or enzyme, the proteinor enzyme is a human protein or enzyme, a fragment of the human proteinor enzyme having a biological activity of a native protein or enzyme, ora polypeptide that has substantial amino acid sequence homology with thehuman protein or enzyme. In some embodiments, the agent is a protein ofhuman or mammalian sequence, origin or derivation, in certain aspects,the protein forms a fusion protein with the megalin ligand or megalinbinding fragment of such a ligand. The active agent polypeptide portionof the fusion protein may be a substance having therapeutic activitysuch as a growth factor, lymphokine or peptide drug. The agent may be anenzyme or other bioactive protein or polypeptide. In other embodiments,the agent is an enzyme or protein whose deficiency causes a humandisease such as Pompe's disease (e.g. alpha-glucosidase). In otherembodiments, the enzyme is selected for its beneficial effect. In otherembodiments, the conjugate is formed by non-covalent bonds between thecarrier and an antibody to which the active agent is attached.

The megalin ligand can also be of human or mammalian sequence origin orderivation. In preferred embodiments, the megalin ligand is selectedfrom the group consisting of RAP, thyroglobulin, lipoprotein lipase,lactoferrin, apolipoprotein J/clusterin, apolipoprotein B,apolipoprotein E, tissue type plasminogen activator, uPA, PAI-1, vitaminD-binding protein, vitamin A/retinol-binding protein, β2-microglobin, a1-microglobulin, vitamin B12/cobalamin plasma carrier protein,transcobalamin (TC)-B12, PTH, insulin, EGF, prolactin, albumin, apo H,transthyretin, lysozyme, cytochrome-c, α-amylase, and aprotinin.

In yet other embodiments of the invention, in each of its aspects, anyof the above megalin ligands are identical to the amino acid sequence ofthe given ligand from a human or mammalian source. In other embodiments,the megalin ligand is the native protein from the human or mammal. Inother embodiments, the RAP or RAP polypeptide is substantiallyhomologous (i.e., at least 80%, 85%, 90%, 95%, 98%, or 99% identical inamino acid sequence) to the native protein over a length of at least 25,50, 100, 150, or 200 amino acids, or the entire length of the megalinligand.

In preferred embodiments, the megalin ligand is RAP or a megalin bindingfragment of RAP. In other embodiments, the subject to which theconjugate is to be administered is human.

In a further aspect, the invention provides a method for deliveringtherapeutic and/or diagnostic/investigational agents to the centralnervous system using the megalin ligand/megalin receptor carrier systemto transport such agents across the BBB formed by the capillaryendothelial cells which are closely sealed by tight junctions. Theinvention thereby provides a novel route of administering agents with asite of action within the central nervous system. In a furtherembodiment, a modulator of megalin is co-administered to modulate thetherapeutic or adverse effects of such a conjugate.

The invention contemplates a method of delivering an agent into thecentral nervous system of an animal comprising administering the animalthe agent conjugated to a megalin binding moiety, wherein the transportof the agent conjugated to the megalin-binding moiety across the bloodbrain barrier of the animal is greater than the transport of the agentin the absence of conjugation to the megalin binding moiety. Alsocontemplated are methods of increasing transcytosis of an agent,comprising conjugating the agent to a megalin-binding moiety, whereintranscytosis of the agent when conjugated to the megalin-binding moietyis greater than the transcytosis of the agent in the absence of theconjugation. The invention also contemplates treating a disorder in amammal comprising administering to the animal a therapeutic agentconjugated to a megalin binding moiety. In the methods of the inventionthe megalin-binding moiety typically improves transcytosis of thetherapeutic agent being delivered. Another method of the invention isfor delivering a therapeutic enzyme to a lysosomal compartment in a cellexpressing megalin, comprising contacting the cell with a compositioncomprising the therapeutic enzyme conjugated to a megalin-bindingmoiety, wherein the uptake of the therapeutic enzyme into the lysosomalcompartment of the cell is mediated through megalin present on thesurface of the cell.

In some embodiments, the conjugated chimeric molecules which comprise amegalin ligand and an active agent comprise more than one therapeuticactive agent useful in treating the same condition or disorder linked toa single megalin ligand. In some embodiments, from about 1 to about 5 orfrom 2 to 10 molecules of the active agent are attached to one megalinligand molecule to be administered to a patient having the disease,condition or disorder.

In another aspect, the invention provides methods for using the megalinreceptor-based delivery in the treatment of diseases, disorders, orconditions. In one group of embodiments, the conjugates of active agentswith a megalin ligand may be used to treat a CNS condition or disorder.In one group of particularly preferred embodiments to be treated, theCNS condition or disorder to be treated is a brain tumor or otherneoplasia (e.g., a CNS tumor such as a glioblastoma). Such tumors orneoplasia may be primary tumors or may be metastases. In theseembodiments, the compounds according to the invention may comprise amegalin ligand or a megalin binding fragment of such a ligand conjugatedto a cancer chemotherapeutic agent. Preferred compounds have from about1 to about 20 molecules of the chemotherapeutic agent covalently linkedto each megalin ligand moiety. Such compounds are excellent vehicles forenhanced delivery of chemotherapeutic agents to brain tumors and otherneoplasia localized in or around the brain, and for improved treatmentof such tumors and neoplasia. In some embodiments, the cancerchemotherapeutic agents conjugated to a megalin ligand polypeptide maybe the same or different. For instance, from 1 to 3 differentchemotherapeutic agents may be attached in the same or a different molesmegalin ligand polypeptide per mole active agent ratio (e.g., 1:1; 1:2;1:3; 1:4; and 1:5 to 1:10) with respect to the megalin ligand or megalinbinding fragment of such a chimeric compound.

Preferred chemotherapeutic agents for such conjugates are cytotoxicchemotherapeutic agents and include, but are not limited to adriamycin,cisplatin, 5-fluorouracil, camptothecin, and paclitaxel. In anotherembodiment, the present invention provides a method of treating apatient with a brain or CNS tumor or glioblastoma by administering tothe patient a therapeutically effective amount of megalin ligandconjugated to the chemotherapeutic agent. In another embodiment, thepresent invention provides for a method for delivering a compound ofinterest through the blood-brain barrier of a subject into the brainparenchyma where the compound is a chemotherapeutic able to interferewith the division of the tumor cells and are toxic for dividing cells.These compounds are liberated in the lysosomes following degradation ofthe vector and can diffuse through the lysosomal membrane and enter thenucleus.

In another group of embodiments, the present invention providescompounds, pharmaceutical compositions, and methods for treatingneurologic and psychiatric diseases and CNS diseases, disorders andconditions, including, but not limited to, Alzheimer's Disease,Parkinson's Disease, Multiple Sclerosis, and Amylotrophic LateralSclerosis. In some embodiments, the compounds of the invention comprisea megalin ligand polypeptide conjugated to a therapeutic agent fortreating such diseases, disorders and conditions. In a preferred groupof embodiments, the therapeutic agent is a peptide including, but notlimited to, Nerve Growth Factor, other peptide hormones or growthfactors, and peptide neurotransmitters. In another embodiment, thepresent invention provides for a method for delivering an active agentthrough the blood-brain barrier of a subject into the brain parenchymawhere the active agent is a neurotrophic factors including, but notlimited to, Nerve Growth Factor, Brain-Derived Neurotrophic Factor,Neurotrophin-3, Neurotrophin-4/5, aFGF, bFGF, CNTF, Leukaemia InhibitoryFactor, Cardiotrophin-1, TGFb, BMPs, GDFs, Neurturin, Artemin,Persephin, EGF, TGFa, Neuregulins, IGF-1, IGF-2, ADNF and PDGFs. Otherfactors such as caspase inhibitors can also be conjugated as the activeagent member of the compound. In other embodiments, the active agent isa therapeutic antibody directed toward a constituent of the CNS. Inother embodiments, the active agent is an antimicrobial agent fortreating or preventing a CNS infection or an immunomodulator such as alymphokine.

In some embodiments, the chimeric molecule that is a conjugate of amegalin ligand (or megalin binding fragment thereof) and an active agentis administered to treat a disease or condition selected from the groupconsisting of neurological diseases including, but not limited to,conditions such as Alzheimer's Disease, Parkinson's Disease,schizophrenia, and epilepsy; neurological cancers, such as primary braintumors including glioma, meningioma, neurinoma, pituitary adenoma,medulloblastoma, craniopharyngioma, hemangioma, epidermoid, sarcoma andintracranial metastasis from other tumor sources, and neurologicalinfections or neurological inflammatory conditions.

Other diseases of the brain also may be treated. Diseases of the brainfall into two general categories: (a) pathologic processes such asinfections, trauma and neoplasm; and, (b) diseases unique to the nervoussystem which include diseases of myelin and degeneration of neurons.Brain-related degenerative diseases resulting from a decrease inneuronal survival include, for example, Alzheimer's disease, Parkinson'sdisease, Huntington's disease, ischemia-related disease and stroke,amyotrophic lateral sclerosis (ALS), spinal muscular atrophy, cerebellardegeneration. Demyelinating diseases include multiple sclerosis (MS) andits variants and perivenous encephalitis. Other diseases in which theprincipal pathologic change is primary demyelination, but which areusually classified in other categories include leukodystrophies such asmetachromatic leukodystrophy due to deficiency of arylsulfatase A,Krabbe's disease due to deficiency of galactocerebrosidebeta-galactosidase, adrenoleukodystrophy and adrenomyeloneuropathy, andpost-viral diseases such as progressive multifocal leukoencephalopathy,acute disseminated encephalomyelitis, acute necrotizing hemorrhagicleukoencephalitis. In addition there are mitochondrialencephalomyopathies. It is contemplated that the conjugates of theinvention may be used in the treatment of such diseases.

In still other aspects, the megalin ligand conjugates of the inventioncan be used to treat non-CNS (i.e., non-BBB delimited diseases, such ascancers, diseases and conditions of non-CNS organs). For example,conjugated agents can be used to treat conditions affecting a patient'smuscles.

In other aspects, the invention provides methods of treating tissues ororgans having proportionately greater, preferably more than two-fold,amounts of megalin receptors on their cells than other tissues ororgans. The selective biodistribution of megalin ligand-conjugatedactive agents can enhance the selective targeting of such conjugatedagents to specific organs.

In a still further aspect, the invention provides a method for using theRAP/megalin carrier system in the diagnosis of diseases, disorders, orconditions. The present invention provides screening assays foridentifying or selecting conjugates of megalin ligand with active agentsthat can prevent, ameliorate, or treat a CNS disease or disorder bymeasuring the transcytosis of such agents in in vitro models or bymeasuring the ability of such conjugates to reach or bind to the brainparenchyma in vivo. Transcytosis or delivery can be assessed by labelingthe conjugate and then monitoring or detecting the location or transportof the label in the test chamber for an in vitro method or in a tissuecompartment(s) in an in vivo method. In addition, a therapeutic effector other biological effect of the conjugate can be used to monitor forpassage of the conjugate into the parenchyma of the central nervoussystem. In preferred embodiments, the CNS condition is a brain tumor.

In another aspect, the invention provides a method of delivering atherapeutic enzyme to a lysosome in a brain cell of a subject,comprising: (i) administering a compound comprising megalin ligand (ormegalin binding fragment thereof) conjugated to the therapeutic enzyme,(ii) transporting such compound across the capillary endothelium; (iii)contact of such compound with an megalin receptor on the cell, therebyfacilitating entry of such compound into such cell by endocytosis; and(iv) delivery to lysosomes within the cell. In certain other aspects,the invention provides such compounds, compositions, and methods fordelivering a therapeutic agent or diagnostic agent to the lysosome of acell.

In yet another aspect, the invention provides a megalin ligand (ormegalin binding fragment thereof) conjugated to a therapeutic enzyme,and method of treating lysosomal storage diseases by administering sucha conjugate, wherein the ligand-enzyme complex binds to megalin receptorand is transported across the cell membrane, enters the cell and isdelivered to the lysosomes within the cell. In some embodiments, theinvention also provides a method of treating a lysosomal storage diseasein a patient by administering a megalin ligand (or megalin bindingfragment thereof) conjugated to a therapeutic agent which is a proteinor enzyme deficient in the lysosomes of a subject having such a disease(e.g., enzyme replacement therapy). Such conjugates are particularlyuseful, for example, in the treatment of lysosomal storage diseases suchas MPS I, MPS II, MPS III A, MPS III B, Metachromatic Leukodystrophy,Gaucher, Krabbe, Pompe, CLN2, Niemann-Pick and Tay-Sachs disease whereina lysosomal protein deficiency contributes to the disease state. In yetother embodiments, the invention also provides a pharmaceuticalcomposition comprising megalin ligand (e.g., RAP) covalently linked to aprotein or enzyme deficient in a lysosomal storage disease.

Thus the invention contemplates methods of treating a lysosomal storagedisease (LSD) in a subject comprising administering to the subject acomposition comprising a megalin-binding moiety conjugated to atherapeutic agent used in the treatment of the LSD, in an amounteffective to ameliorate the symptoms of the LSD. Typically, in such amethod the composition is a pharmaceutical composition and isadministered in an amount effective to decrease the amount of storagegranules present in the brain tissue of the mammal. The administrationmay be intrathecal administration into the central nervous system of themammal. Preferably, the composition is administered in an amounteffective to decrease the amount of storage granules present in themeningeal tissue of the mammal. The symptoms of LSD are monitored usingtechniques known to those of skill in the art and are typicallymonitored through routine assessment of history, physical examination,echocardiography, electrocardiography, magnetic resonance imaging,polysomnography, skeletal survey, range of motion measurements, cornealphotographs, and skin biopsy.

In some embodiments, the compounds, compositions, and methods of theinvention can be used to treat such lysosomal storage diseases asAspartylglucosaminuria, Cholesterol ester storage disease/Wolmandisease, Cystinosis, Danon disease, Fabry disease, FarberLipogranulomatosis/Farber disease, Fucosidosis, Galactosialidosis typesI/II, Gaucher disease types I/II/III Gaucher disease, Globoid cellleukodystrophy/Krabbe disease, Glycogen storage disease II/Pompedisease, GM1-Gangliosidosis types I/II/III, GM2-Gangliosidosis typeI/Tay-Sachs disease, GM2-Gangliosidosis type II Sandhoff disease,GM2-Gangliosidosis, alpha-Mannosidosis types I/II, alpha-Mannosidosis,Metachromatic leukodystrophy, Mucolipidosis type I/Sialidosis types I/IIMucolipidosis types II/III I-cell disease, Mucolipidosis type IIICpseudo-Hurler polydystrophy, Mucopolysaccharidosis type I,Mucopolysaccharidosis type II Hunter syndrome, Mucopolysaccharidosistype IIIA Sanfilippo syndrome, Mucopolysaccharidosis type IIIBSanfilippo syndrome, Mucopolysaccharidosis type IIIC Sanfilipposyndrome, Mucopolysaccharidosis type IIID Sanfilippo syndrome,Mucopolysaccharidosis type IVA Morquio syndrome, Mucopolysaccharidosistype IVB Morquio syndrome, Mucopolysaccharidosis type VI,Mucopolysaccharidosis type VII Sly syndrome, Mucopolysaccharidosis typeIX, Multiple sulfatase deficiency, Pompe, Neuronal CeroidLipofuscinosis, CLN1 Batten disease, Neuronal Ceroid Lipofuscinosis,CLN2 Batten disease, Niemann-Pick disease types A/B Niemann-Pickdisease, Niemann-Pick disease type C1 Niemann-Pick disease, Niemann-Pickdisease type C2 Niemann-Pick disease, Pycnodysostosis, Schindler diseasetypes III Schindler disease, and Sialic acid storage disease. Inparticularly preferred embodiments, the lysosomal storage disease is MPSIII, MLD, or GM1.

In still another embodiment, the present invention provides for a methodof enzyme replacement therapy by administering a therapeuticallyeffective amount of a conjugate to a subject in need of the enzymereplacement therapy, wherein the conjugate comprises a megalin ligand(or megalin binding fragment thereof) linked to an enzyme via a linker,wherein the cells of the patient have lysosomes which containinsufficient amounts of the enzyme to prevent or reduce damage to thecells, whereby sufficient amounts of the enzyme enter the lysosomes toprevent or reduce damage to the cells. The cells may be within orwithout the CNS and may but need not be set off from the blood bycapillary walls whose endothelial cells are closely sealed to diffusionof an active agent by tight junctions.

In some embodiments, the megalin ligand conjugates with an active agentcomprise more than one active agent for treating a lysosomal storagedisease linked to a single megalin ligand. In some embodiments, fromabout 1 to about 5 or from 2 to 10 molecules of the active agent ofinterest are bound to a single megalin ligand molecule.

In a particular embodiment, the invention provides compounds comprisinga megalin ligand bound to an active agent having a biological activitywhich is reduced, deficient, or absent in the target lysosome of thesubject to which the compound is administered. In preferred embodiments,the megalin ligand (or megalin binding fragment thereof) is covalentlybound to the active agent. Preferred active agents include, but are notlimited to aspartylglucosaminidase, acid lipase, cysteine transporter,Lamp-2, alpha-galactosidase A, acid ceramidase, alpha-L-fucosidase,beta-hexosaminidase A, GM2-activator deficiency, alpha-D-mannosidase,beta-D-mannosidase, arylsulfatase A, saposin B, neuraminidase,alpha-N-acetylglucosaminidase phosphotransferase, phosphotransferaseγ-subunit, alpha-L-iduronidase, iduronate-2-sulfatase,heparan-N-sulfatase, alpha-N-acetylglucosaminidase,acetylCoA:N-acetyltransferase, N-acetylglucosamine 6-sulfatase,galactose 6-sulfatase, alpha-galactosidase, N-acetylgalactosamine4-sulfatase, hyaluronoglucosaminidase, palmitoyl protein thioesterase,tripeptidyl peptidase I, acid sphingomyelinase, cholesterol trafficking,cathepsin K, beta-galactosidase B, α-glucosidase, and sialic acidtransporter. In a preferred embodiment, alpha-L-iduronidase,α-glucosidase or N-acetylgalactosamine 4-sulfatase is the enzyme.

In specific embodiments, the disease being treated by the methodsprovided herein mucopolysaccharidosis, more particularly,mucopolysaccharidosis I. In specific embodiments, the mammal with theLSD demonstrates about 50% or less of a normal α-L-iduronidase activity.Typically, the pharmaceutical composition is administered at a dose ofbetween about 0.001 mg/kg body weight and 0.5 mg/kg body weight of thehuman α-L-iduronidase administered weekly to a subject suffering from adeficiency thereof. These are merely exemplary and those of skill in theart may employ other doses to achieve therapeutically effective results.Further it should be understood that dosage form is cited herein asmg/kg body weight, however, those of skill in the art will be aware ofother dosage measurements that may be used instead. In some embodiments,the pharmaceutical composition is administered at a dose of betweenabout 0.01 mg/l 5 cc of CSF to about 5.0 mg/15 cc of CSF of the mammalof the human α-L-iduronidase is administered weekly to a subjectsuffering from a deficiency thereof. In the treatment of LSD, theadministration of the megalin-binding moiety conjugated to a therapeuticagent preferably results in normalization of developmental delay andregression in the subject, reduction in high pressure hydrocephalus,reduction in spinal cord compression in the subject, and reduction innumber and/or size of perivascular cysts around the brain vessels of thesubject. Where the administration is intrathecal, such administrationmay comprise introducing the pharmaceutical composition into a cerebralventricle. The methods may comprise intrathecal administration thatintroduces the pharmaceutical composition into the lumbar area or thecisterna magna. Intrathecal administration may be effected through theuse of e.g., an infusion pump. It may be a continuous administrationover a period of time. Typically, the period of time may be at leastseveral days. Preferably, the mammal being treated is a human.

Also contemplated is a method of promoting the breakdown ofglycosaminoglycan (GAG) in a brain cell of a subject having lysosomalstorage disease, the method comprising administering to the subject apharmaceutical composition comprising an enzyme deficient in thelysosomal storage disease conjugated to a megalin-binding moiety in anamount effective to reduce the amount of GAG present in the brain cellas compared to the amount of GAG present in the cell prior to theadministration. Preferably, the brain cell is a neuron, glial cell,microglial cell, astrocyte, oligodendroglial cell, perivascular cell,perithelial cell, meningeal cell, ependymal cell, arachnoid granulationcell, arachnoid membrane, dura mater, pia mater and choroid plexus cell.In these methods, the subject may manifest a symptom of high pressurehydrocephalus and the administering reduces the amount of CSF fluid inthe meningeal tissue of the subject. In other aspects, the number oflysosomal storage granules in the cell are reduced as compared to thenumber of lysosomal storage granules present in a similar cell in theabsence of administration of the conjugate. In other embodiments, thenumber of lysosomal storage granules in the cell are reduced as comparedto the number of lysosomal storage granules present in a similar celltreated with enzyme alone without conjugation to the megalin-bindingmoiety.

In another aspect, the invention provides screening assays foridentifying megalin ligand (or megalin binding fragment thereof)conjugated to active agent that can prevent, ameliorate, or treat alysosomal storage disease by contacting a cell containing a lysosomewith the conjugate and determining whether the conjugate delivers theagent to the lysosome. The delivery can be assessed by labeling theconjugate and then monitoring or detecting the location of the label inthe cell or by determining the effect of the conjugate on the amount ofthe storage material found in the lysosome. In a preferred embodiment,the agent is a protein or enzyme deficient in the lysosomal storagedisease. In another embodiment, the cell is deficient in the agentconjugated to the megalin ligand.

In another embodiment, the present invention provides for a method foridentifying an agent that can prevent, ameliorate or treat a lysosomalstorage disease, by administering megalin ligand (or megalin bindingfragment thereof) conjugated enzyme to a cell, wherein absence of theenzyme causes the lysosomal storage disease; and determining whether theagent reduces damage to the cell compared to damage to the cell if theconjugated agent was not administered to the cell. In certainembodiments, the method is a high throughput assay.

Other features and advantages of the invention will become apparent fromthe following detailed description. It should be understood, however,that the detailed description and the specific examples, whileindicating preferred embodiments of the invention, are given by way ofillustration only, because various changes and modifications within thespirit and scope of the invention will become apparent to those skilledin the art from this detailed description.

BRIEF DESCRIPTION OF THE FIGURES

The following drawings form part of the present specification and areincluded to further illustrate aspects of the present invention. Theinvention may be better understood by reference to the drawings incombination with the detailed description of the specific embodimentspresented herein.

FIG. 1. Effect of RAP on [¹²⁵I]-p97 transcytosis across BBCECmonolayers.

FIG. 2. Preparation of expression constructs encoding fusions betweenhuman RAP and human glucosidase (GAA), alpha-L-iduronidase (IDU) andglial-derived neurotrophic factor (GDNF). (RAPF primer: SEQ ID NO:12;RAPR primer SEQ ID NO:13; GAA forward primer SEQ ID NO:14; GAA reverseprimer SEQ ID NO:15; IDU forward primer SEQ ID NO:16; IDU reverse primerSEQ ID NO:17; GDNF forward primer SEQ ID NO:18; GDNF reverse primer SEQID NO:19; RAPBACF primer SEQ ID NO:20.)

FIG. 3. Nucleotide and protein sequences of the RAP-GAA fusion(nucleotide sequence: SEQ ID NO:6; protein sequence: SEQ ID NO:7).

FIG. 4. Nucleotide and protein sequence of RAP-IDU fusion (nucleotidesequence: SEQ ID NO:8; protein sequence: SEQ ID NO:9).

FIG. 5. Nucleotide and protein sequence of RAP-GDNF fusion (nucleotidesequence: SEQ ID NO:10; protein sequence: SEQ ID NO:11).

FIG. 6. Characterization of the RAP-GAA fusion.

FIG. 7. Assay for complex oligosaccharides on RAP-GAA.

FIG. 8. Assay for high-mannose oligosaccharides on RAP-GAA.

FIG. 9. Characterization of RAP-IDU fusion.

FIG. 10. Binding of RAP and RAP-lysosomal enzyme fusion to LRP.

FIG. 11. Corrected Vd vs. perfusion time for iodinated RAP andtransferrin at 15 minutes.

FIG. 12. Distribution of RAP between brain capillary endothelium andbrain parenchyma.

FIG. 13. RAP-alpha-glucosidase uptake by human Pompe fibroblasts.

FIG. 14. Multiple alignment of amino acid sequences of RAP fromdifferent species: human (SEQ ID NO:21); mouse (SEQ ID NO:22); rat (SEQID NO:23); chicken (SEQ ID NO:24); zebrafish (SEQ ID NO:25); fruit fly(SEQ ID NO:26); mosquito (SEQ ID NO:27); flatworm (SEQ ID NO:28).

FIG. 15. SEQ ID NO:1, amino acid sequence of human RAP.

FIG. 16. SEQ ID NO:2, amino acid sequence of the 28 kD RAP polypeptide.

FIG. 17. Transcytosis is bovine brain capillary endothelial cells.

FIG. 18. Transport of ¹²⁵I-RAP in MDCK cells showingbasolateral-to-apical flux.

FIG. 19A-19C. FIG. 19A Gel and blot analysis of RAP fusions: RAP-IDU, A;RAP-GAA, B. Coomassie Blue staining, lane 1; anti-RAP antibody, lane 2;anti-IDU or anti-GAA antibody, lane 3. FIG. 19B. Kinetic analysis ofrhIDU and RAP-IDU: Proteins (1 nM) were incubated at room temperaturefor 5 minutes in different concentrations of 4-MUI. Derived V_(max) andK_(m) values are listed in Table A. FIG. 19C. In vitro proteolysis ofRAP fusions: Fusions were treated with a mixture of cathepsins, resolvedon SDS-PAGE gels and stained with Coomassie Blue. Undigested RAP-GAAfusion, lane 1; proteolyzed RAP-GAA fusion, lane 2; rhGAA, lane 3;undigested RAP-IDU fusion, lane 4; proteolyzed RAP-IDU fusion, lane 5;rhIDU, lane 6; RAP, lane 7; molecular weight markers, lane 8.

FIG. 20A-20C. FIG. 20A. Fluorophore-assisted carbohydrateelectrophoresis (FACE) of rhGAA (A), RAP-GAA (A), rhIDU (B) and RAP-IDU(B): N-linked oligosaccharides were released, fluorescently labeled atthe reducing terminus and electrophoresed. Fluorescent bands wereanalyzed on a FACE imager system. Band intensity is proportional to themolar amount of particular oligosaccharides present. Oligoglucose laddercalibrated in degree of polymerization (DP) units, lane 1; rhGAA (A) orrhIDU (B), lane 2; RAP-GAA (A) or RAP-IDU (B), lane 3. The prominentband near the bottom of lane 2 in both A and B marked by the arrow isBis-7. FIG. 20B. Isoelectric focusing analysis of RAP-GAA for complexoligosaccharides: Proteins were treated with Clostrium perfringensneuraminidase, resolved on PhastGels and silver stained. Untreated rhIDU(positive control), lane 1; rhIDU treated with neuraminidase, lane 2;untreated RAP-GAA, lane 3; RAP-GAA treated with neuraminidase, lane 4;pI standards, lane 5. FIG. 20C. Endo H and N-glycanase digestion ofproteolyzed RAP-GAA and RAP-IDU: Fusions were proteolyzed with a mixtureof cathepsins, treated with Endo H or N-glycanase, resolved on SDS-PAGEgels and stained with Coomassie Blue. Molecular weight standards, lanes1 and 10. RAP-GAA, lane 2; proteolyzed RAP-GAA, lane 3; proteolyzed,endo H digested RAP-GAA, lane 4; proteolyzed, N-glycanase digestedRAP-GAA, lane 5; RAP-IDU, lane 6; proteolyzed RAP-IDU, lane 7;proteolyzed, endo H digested RAP-IDU, lane 8; proteolyzed, N-glycanasedigested RAP-IDU, lane 9. Interpolated molecular weights are printedunder each band.

FIG. 21. sLRP2 ligand blot: The second ligand-binding domain of LRP1 wasblotted to nylon membrane and probed with ligands in the presence orabsence of excess RAP. Bound ligands were detected by Western blottingwith indicated antibodies. Ligands were: Buffer alone, column A; RAP,column B; RAP-IDU, column C; rhIDU, column D.

FIG. 22A-22F. FIG. 22A: Uptake of RAP-IDU and rhIDU into GM1391fibroblasts: Different concentrations of proteins were incubated withfibroblasts for 2 hours. After washing, fibroblasts were lysed anduptake was measured by enzymatic assay. Curves were fitted and constantsderived as described. Inset: Plot of rhIDU data alone. FIG. 22B: Uptakeof RAP-GAA and rhGAA into GM244 fibroblasts: Different concentrations ofproteins were incubated with fibroblasts for 2 hours. After washing,fibroblasts were lysed and uptake was measured by enzymatic assay.Curves were fitted and constants derived as described. Inset: Plot ofrhGAA data alone. FIG. 22C: Inhibition of RAP-IDU uptake into GM1391fibroblasts: RAP-IDU (3 nM) was incubated with fibroblasts in thepresence of different concentrations of RAP for 2 hours. After washing,fibroblasts were lysed and uptake was measured by iduronidase enzymaticassay. FIG. 22D: Inhibition of RAP-GAA uptake into GM244 fibroblasts:RAP-GAA (5 nM) was incubated with fibroblasts in the presence ofdifferent inhibitors for 2 hours. After washing, fibroblasts were lysedand uptake was measured by enzymatic assay. FIG. 22E. Inhibition ofRAP-GAA (gray) and rhGAA (black) uptake into C6 glioma cells: Proteins(5 nM) were incubated with C6 glioma cells in the presence of inhibitorsfor 2 hours. After washing, fibroblasts were lysed and uptake wasmeasured by enzymatic assay. ND=not done. FIG. 22F Inhibition of RAP-GAAuptake (gray) and rhGAA uptake (black) into C2C12 myoblasts: RAP-GAA andrhGAA, both at 5 nM, were incubated with cells in the presence ofinhibitors for 2 hours. After washing, fibroblasts were lysed and uptakewas measured by enzymatic assay.

FIG. 23 RAP-GAA uptake mediated by different LRP receptors: Valuesrepresent the difference between uptake in the presence and absence ofexcess cold RAP (receptor-specific uptake). Femtomoles of solubilized¹²⁵I were normalized to total protein in each sample.

FIG. 24 Intra-cellular half-life of RAP-GAA and rhGAA in GM244fibroblasts: Proteins were incubated with fibroblasts for 24 hours.Medium was changed and cells were allowed to grow for intervals from 2to 14 days, followed by lysis and alpha-glucosidase enzyme assay.

FIG. 25A-25B. FIG. 25A. Clearance of stored glycosaminoglycan in Hurlerfibroblasts by rhIDU and RAP-IDU: Cells were labeled in triplicate with³⁵S-sulfate in the presence of rhIDU or RAP-IDU for 48 hours. Labeledcells were then washed, lysed and assayed for radioactivity and totalprotein. FIG. 25B: SDS-PAGE analysis of proteins used for experiment,stained with Coomassie Blue. RAP-IDU, lane 1; rhIDU, lane 2.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Despite the fact that there have been significant advances made in thedesign and delivery of therapeutic agent across the blood brain barrier,there remains a need for new agents that may produce additionalcompounds that can mediate the transcytosis of therapeutic agents.

The present invention relates to the discovery that RAP and RAPpolypeptides selectively bind to megalin receptors. RAP is aparticularly effective megalin ligand for delivering active agentsconjugated to it across the blood brain barrier, to the lysosomes withina cell, and to the intracellular compartment of cells bearing megalinreceptors. Other megalin ligands also are exemplified herein as beinguseful in mediating such delivery. Compounds comprising megalin ligand(or megalin binding fragment thereof) conjugated to an active agent areuseful in the diagnosis and treatment of a variety of CNS and non-CNSdiseases, conditions, and disorders, including but not limited to, inparticular, cancer and lysosomal storage diseases. Methods andcompositions for exploiting these findings are described in furtherdetail below.

1. DEFINITIONS

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. The following referencesprovide one of skill with a general definition of many of the terms usedin this invention: Singleton, et al., DICTIONARY OF MICROBIOLOGY ANDMOLECULAR BIOLOGY (2d ed. 1994); THE CAMBRIDGE DICTIONARY OF SCIENCE ANDTECHNOLOGY (Walker ed., 1988); THE GLOSSARY OF GENETICS, 5TH ED., R.Rieger, et al. (eds.), Springer Verlag (1991); and Hale and Marham, THEHARPER COLLINS DICTIONARY OF BIOLOGY (1991).

Each publication, patent application, patent, and other reference citedherein is incorporated by reference in its entirety to the extent thatit is not inconsistent with the present disclosure.

It is noted here that as used in this specification and the appendedclaims, the singular forms “a,” “an,” and “the” include plural referenceunless the context clearly dictates otherwise.

As used herein, the following terms have the meanings ascribed to themunless specified otherwise.

“Brain tumors and other neoplasia in or around the brain” as used hereinincludes both primary tumors and/or metastases that develop in or aroundthe brain. It may also mean metastases of brain tumors that migrateelsewhere in the body, but remain responsive to RAP or RAP polypeptideconjugates with chemotherapeutic agents. Many types of such tumors andneoplasia are known. Primary brain tumors include glioma, meningioma,neurinoma, pituitary adenoma, medulloblastoma, craniopharyngioma,hemangioma, epidermoid, sarcoma and others. Fifty percent of allintracranial tumors are intracranial metastasis. As used herein, tumorsand neoplasia may be associated with the brain and neural tissue, orthey may be associated with the meninges, skull, vasculature or anyother tissue of the head or neck. Such tumors are generally solidtumors, or they are diffuse tumors with accumulations localized to thehead. Tumors or neoplasia for treatment according to the invention maybe malignant or benign, and may have been treated previously withchemotherapy, radiation and/or other treatments.

The term “effective amount” means a dosage sufficient to produce adesired result on a health condition, pathology, and disease of asubject or for a diagnostic purpose. The desired result may comprise asubjective or objective improvement in the recipient of the dosage.“Therapeutically effective amount” refers to that amount of an agenteffective to produce the intended beneficial effect on health.

“Small organic molecule” refers to organic molecules of a sizecomparable to those organic molecules generally used in pharmaceuticals.The term excludes organic biopolymers (e.g., proteins, nucleic acids,etc.). Preferred small organic molecules range in size up to about 5000Da, up to about 2000 Da, or up to about 1000 Da.

A “subject” of diagnosis or treatment is a human or non-human animal,including a mammal or a primate.

“Treatment” refers to prophylactic treatment or therapeutic treatment ordiagnostic treatment.

A “prophylactic” treatment is a treatment administered to a subject whodoes not exhibit signs of a disease or exhibits only early signs for thepurpose of decreasing the risk of developing pathology. The conjugatecompounds of the invention may be given as a prophylactic treatment toreduce the likelihood of developing a pathology or to minimize theseverity of the pathology, if developed.

A “therapeutic” treatment is a treatment administered to a subject whoexhibits signs or symptoms of pathology for the purpose of diminishingor eliminating those signs or symptoms. The signs or symptoms may bebiochemical, cellular, histological, functional, subjective orobjective. The conjugate compounds of the invention may be given as atherapeutic treatment or for diagnosis.

“Diagnostic” means identifying the presence or nature of a pathologiccondition. Diagnostic methods differ in their specificity andselectivity. While a particular diagnostic method may not provide adefinitive diagnosis of a condition, it suffices if the method providesa positive indication that aids in diagnosis.

“Pharmaceutical composition” refers to a composition suitable forpharmaceutical use in subject animal, including humans and mammals. Apharmaceutical composition comprises a pharmacologically effectiveamount of a RAP polypeptide conjugated to an active agent and alsocomprises a pharmaceutically acceptable carrier. A pharmaceuticalcomposition encompasses a composition comprising the activeingredient(s), and the inert ingredient(s) that make up the carrier, aswell as any product which results, directly or indirectly, fromcombination, complexation or aggregation of any two or more of theingredients, or from dissociation of one or more of the ingredients, orfrom other types of reactions or interactions of one or more of theingredients. Accordingly, the pharmaceutical compositions of the presentinvention encompass any composition made by admixing a conjugatecompound of the present invention and a pharmaceutically acceptablecarrier.

“Pharmaceutically acceptable carrier” refers to any of the standardpharmaceutical carriers, buffers, and excipients, such as a phosphatebuffered saline solution, 5% aqueous solution of dextrose, andemulsions, such as an oil/water or water/oil emulsion, and various typesof wetting agents and/or adjuvants. Suitable pharmaceutical carriers andformulations are described in Remington's Pharmaceutical Sciences, 19thEd. (Mack Publishing Co., Easton, 1995). Preferred pharmaceuticalcarriers depend upon the intended mode of administration of the activeagent. Typical modes of administration include enteral (e.g., oral) orparenteral (e.g., subcutaneous, intramuscular, intravenous orintraperitoneal injection; or topical, transdermal, or transmucosaladministration). A “pharmaceutically acceptable salt” is a salt that canbe formulated into a compound for pharmaceutical use including, e.g.,metal salts (sodium, potassium, magnesium, calcium, etc.) and salts ofammonia or organic amines.

The term “unit dosage form,” as used herein, refers to physicallydiscrete units suitable as unitary dosages for human and animalsubjects, each unit containing a predetermined quantity of compounds ofthe present invention calculated in an amount sufficient to produce thedesired effect in association with a pharmaceutically acceptablediluent, carrier or vehicle. The specifications for the novel unitdosage forms of the present invention depend on the particular conjugateemployed and the effect to be achieved, and the pharmacodynamicsassociated with each compound in the host.

“Modulate,” as used herein, refers to the ability to alter, by increaseor decrease (e.g., to act as an antagonist or agonist).

“Increasing relative delivery” as used herein refers to the effectwhereby the accumulation at the intended delivery site (e.g., brain,lysosome) of a RAP-conjugated active agent is increased relative to theaccumulation of the unconjugated active agent.

“Therapeutic index” refers to the dose range (amount and/or timing)above the minimum therapeutic amount and below an unacceptably toxicamount.

“Equivalent dose” refers to a dose, which contains the same amount ofactive agent.

“Polynucleotide” refers to a polymer composed of nucleotide units.Polynucleotides include naturally occurring nucleic acids, such asdeoxyribonucleic acid (“DNA”) and ribonucleic acid (“RNA”) as well asnucleic acid analogs. Nucleic acid analogs include those which includenon-naturally occurring bases, nucleotides that engage in linkages withother nucleotides other than the naturally occurring phosphodiester bondor which include bases attached through linkages other thanphosphodiester bonds. Thus, nucleotide analogs include, for example andwithout limitation, phosphorothioates, phosphorodithioates,phosphorotriesters, phosphoramidates, boranophosphates,methylphosphonates, chiral-methyl phosphonates, 2-O-methylribonucleotides, peptide-nucleic acids (PNAs), and the like. Suchpolynucleotides can be synthesized, for example, using an automated DNAsynthesizer. The term “nucleic acid” typically refers to largepolynucleotides. The term “oligonucleotide” typically refers to shortpolynucleotides, generally no greater than about 50 nucleotides. It willbe understood that when a nucleotide sequence is represented by a DNAsequence (i.e., A, T, G, C), this also includes an RNA sequence (i.e.,A, U, G, C) in which “U” replaces “T.”

“cDNA” refers to a DNA that is complementary or identical to an mRNA, ineither single stranded or double stranded form.

Conventional notation is used herein to describe polynucleotidesequences: the left-hand end of a single-stranded polynucleotidesequence is the 5′-end; the left-hand direction of a double-strandedpolynucleotide sequence is referred to as the 5′-direction. Thedirection of 5′ to 3′ addition of nucleotides to nascent RNA transcriptsis referred to as the transcription direction. The DNA strand having thesame sequence as an mRNA is referred to as the “coding strand”;sequences on the DNA strand having the same sequence as an mRNAtranscribed from that DNA and which are located 5′ to the 5′-end of theRNA transcript are referred to as “upstream sequences”; sequences on theDNA strand having the same sequence as the RNA and which are 3′ to the3′ end of the coding RNA transcript are referred to as “downstreamsequences.”

“Complementary” refers to the topological compatibility or matchingtogether of interacting surfaces of two polynucleotides. Thus, the twomolecules can be described as complementary, and furthermore, thecontact surface characteristics are complementary to each other. A firstpolynucleotide is complementary to a second polynucleotide if thenucleotide sequence of the first polynucleotide is identical to thenucleotide sequence of the polynucleotide binding partner of the secondpolynucleotide. Thus, the polynucleotide whose sequence 5′-TATAC-3′ iscomplementary to a polynucleotide whose sequence is 5′-GTATA-3′.

A nucleotide sequence is “substantially complementary” to a referencenucleotide sequence if the sequence complementary to the subjectnucleotide sequence is substantially identical to the referencenucleotide sequence.

“Encoding” refers to the inherent property of specific sequences ofnucleotides in a polynucleotide, such as a gene, a cDNA, or an mRNA, toserve as templates for synthesis of other polymers and macromolecules inbiological processes having either a defined sequence of nucleotides(i.e., rRNA, tRNA and mRNA) or a defined sequence of amino acids and thebiological properties resulting therefrom. Thus, a gene encodes aprotein if transcription and translation of mRNA produced by that geneproduces the protein in a cell or other biological system. Both thecoding strand, the nucleotide sequence of which is identical to the mRNAsequence and is usually provided in sequence listings, and non-codingstrand, used as the template for transcription, of a gene or cDNA can bereferred to as encoding the protein or other product of that gene orcDNA. Unless otherwise specified, a “nucleotide sequence encoding anamino acid sequence” includes all nucleotide sequences that aredegenerate versions of each other and that encode the same amino acidsequence. Nucleotide sequences that encode proteins and RNA may includeintrons.

“Recombinant polynucleotide” refers to a polynucleotide having sequencesthat are not naturally joined together. An amplified or assembledrecombinant polynucleotide may be included in a suitable vector, and thevector can be used to transform a suitable host cell. A host cell thatcomprises the recombinant polynucleotide is referred to as a“recombinant host cell.” The gene is then expressed in the recombinanthost cell to produce, e.g., a “recombinant polypeptide.” A recombinantpolynucleotide may serve a non-coding function (e.g., promoter, originof replication, ribosome-binding site, etc.) as well.

“Expression control sequence” refers to a nucleotide sequence in apolynucleotide that regulates the expression (transcription and/ortranslation) of a nucleotide sequence operatively linked thereto.“Operatively linked” refers to a functional relationship between twoparts in which the activity of one part (e.g., the ability to regulatetranscription) results in an action on the other part (e.g.,transcription of the sequence). Expression control sequences caninclude, for example and without limitation, sequences of promoters(e.g., inducible or constitutive), enhancers, transcription terminators,a start codon (i.e., ATG), splicing signals for introns, and stopcodons.

“Expression vector” refers to a vector comprising a recombinantpolynucleotide comprising expression control sequences operativelylinked to a nucleotide sequence to be expressed. An expression vectorcomprises sufficient cis-acting elements for expression; other elementsfor expression can be supplied by the host cell or in vitro expressionsystem. Expression vectors include all those known in the art, such ascosmids, plasmids (e.g., naked or contained in liposomes) and virusesthat incorporate the recombinant polynucleotide.

“Amplification” refers to any means by which a polynucleotide sequenceis copied and thus expanded into a larger number of polynucleotidemolecules, e.g., by reverse transcription, polymerase chain reaction,and ligase chain reaction.

“Primer” refers to a polynucleotide that is capable of specificallyhybridizing to a designated polynucleotide template and providing apoint of initiation for synthesis of a complementary polynucleotide.Such synthesis occurs when the polynucleotide primer is placed underconditions in which synthesis is induced, i.e., in the presence ofnucleotides, a complementary polynucleotide template, and an agent forpolymerization such as DNA polymerase. A primer is typicallysingle-stranded, but may be double-stranded. Primers are typicallydeoxyribonucleic acids, but a wide variety of synthetic and naturallyoccurring primers are useful for many applications. A primer iscomplementary to the template to which it is designed to hybridize toserve as a site for the initiation of synthesis, but need not reflectthe exact sequence of the template. In such a case, specifichybridization of the primer to the template depends on the stringency ofthe hybridization conditions. Primers can be labeled with, e.g.,chromogenic, radioactive, or fluorescent moieties and used as detectablemoieties.

“Probe,” when used in reference to a polynucleotide, refers to apolynucleotide that is capable of specifically hybridizing to adesignated sequence of another polynucleotide. A probe specificallyhybridizes to a target complementary polynucleotide, but need notreflect the exact complementary sequence of the template. In such acase, specific hybridization of the probe to the target depends on thestringency of the hybridization conditions. Probes can be labeled with,e.g., chromogenic, radioactive, or fluorescent moieties and used asdetectable moieties.

A first sequence is an “antisense sequence” with respect to a secondsequence if a polynucleotide whose sequence is the first sequencespecifically hybridizes with a polynucleotide whose sequence is thesecond sequence.

“Hybridizing specifically to” or “specific hybridization” or“selectively hybridize to”, refers to the binding, duplexing, orhybridizing of a nucleic acid molecule preferentially to a particularnucleotide sequence under stringent conditions when that sequence ispresent in a complex mixture (e.g., total cellular) DNA or RNA.

The term “stringent conditions” refers to conditions under which a probewill hybridize preferentially to its target subsequence, and to a lesserextent to, or not at all to, other sequences. “Stringent hybridization”and “stringent hybridization wash conditions” in the context of nucleicacid hybridization experiments such as Southern and Northernhybridizations are sequence dependent, and are different under differentenvironmental parameters. An extensive guide to the hybridization ofnucleic acids is found in Tijssen (1993) Laboratory Techniques inBiochemistry and Molecular Biology—Hybridization with Nucleic AcidProbes part I chapter 2 “Overview of principles of hybridization and thestrategy of nucleic acid probe assays”, Elsevier, N.Y. Generally, highlystringent hybridization and wash conditions are selected to be about 5°C. lower than the thermal melting point (Tm) for the specific sequenceat a defined ionic strength and pH. The Tm is the temperature (underdefined ionic strength and pH) at which 50% of the target sequencehybridizes to a perfectly matched probe. Very stringent conditions areselected to be equal to the Tm for a particular probe.

An example of stringent hybridization conditions for hybridization ofcomplementary nucleic acids which have more than 100 complementaryresidues on a filter in a Southern or northern blot is 50% formalin with1 mg of heparin at 42° C., with the hybridization being carried outovernight. An example of highly stringent wash conditions is 0.15 M NaClat 72° C. for about 15 minutes. An example of stringent wash conditionsis a 0.2×SSC wash at 65° C. for 15 minutes (see, Sambrook et al. for adescription of SSC buffer). Often, a high stringency wash is preceded bya low stringency wash to remove background probe signal. An examplemedium stringency wash for a duplex of, e.g., more than 100 nucleotides,is 1×SSC at 45° C. for 15 minutes. An example low stringency wash for aduplex of, e.g., more than 100 nucleotides, is 4-6×SSC at 40° C. for 15minutes. In general, a signal to noise ratio of 2× (or higher) than thatobserved for an unrelated probe in the particular hybridization assayindicates detection of a specific hybridization.

“Polypeptide” refers to a polymer composed of amino acid residues,related naturally occurring structural variants, and syntheticnon-naturally occurring analogs thereof linked via peptide bonds,related naturally occurring structural variants, and syntheticnon-naturally occurring analogs thereof. Synthetic polypeptides can besynthesized, for example, using an automated polypeptide synthesizer.The term “protein” typically refers to large polypeptides. The term“peptide” typically refers to short polypeptides.

Conventional notation is used herein to portray polypeptide sequences:the left-hand end of a polypeptide sequence is the amino-terminus; theright-hand end of a polypeptide sequence is the carboxyl-terminus.

1) Alanine (A), Serine (S), Threonine (T);

2) Aspartic acid (D), Glutamic acid (E);

3) Asparagine (N), Glutamine (Q);

4) Arginine (R), Lysine (K);

5) Isoleucine (I), Leucine (L), Methionine (M), Valine (V); and

6) Phenylalanine (F), Tyrosine (Y), Tryptophan (W).

“Allelic variant” refers to any of two or more polymorphic forms of agene occupying the same genetic locus. Allelic variations arisenaturally through mutation, and may result in phenotypic polymorphismwithin populations. Gene mutations can be silent (no change in theencoded polypeptide) or may encode polypeptides having altered aminoacid sequences. “Allelic variants” also refer to cDNAs derived from mRNAtranscripts of genetic allelic variants, as well as the proteins encodedby them.

The terms “identical” or percent “identity,” in the context of two ormore polynucleotide or polypeptide sequences, refer to two or moresequences or subsequences that are the same or have a specifiedpercentage of nucleotides or amino acid residues that are the same, whencompared and aligned for maximum correspondence, as measured using oneof the following sequence comparison algorithms or by visual inspection.

The phrase “substantially homologous” or “substantially identical” inthe context of two nucleic acids or polypeptides, generally refers totwo or more sequences or subsequences that have at least 40%, 60%, 80%,90%, 95%, 98% nucleotide or amino acid residue identity, when comparedand aligned for maximum correspondence, as measured using one of thefollowing sequence comparison algorithms or by visual inspection.Preferably, the substantial identity exists over a region of thesequences that is at least about 50 residues in length, more preferablyover a region of at least about 100 residues, and most preferably thesequences are substantially identical over at least about 150 residues.In a most preferred embodiment, the sequences are substantiallyidentical over the entire length of either or both comparisonbiopolymers.

For sequence comparison, typically one sequence acts as a referencesequence, to which test sequences are compared. When using a sequencecomparison algorithm, test and reference sequences are input into acomputer, subsequence coordinates are designated, if necessary, andsequence algorithm program parameters are designated. The sequencecomparison algorithm then calculates the percent sequence identity forthe test sequence(s) relative to the reference sequence, based on thedesignated program parameters.

Optimal alignment of sequences for comparison can be conducted, e.g., bythe local homology algorithm of Smith and Waterman, Adv. Appl. Math.2:482 (1981), by the homology alignment algorithm of Needleman andWunsch, J. Mol. Biol. 48:443 (1970), by the search for similarity methodof Pearson and Lipman, Proc. Natl. Acad. Sci. USA 85:2444 (1988), bycomputerized implementations of these algorithms (GAP, BESTFIT, FASTA,and TFASTA in the Wisconsin Genetics Software Package, Genetics ComputerGroup, 575 Science Dr., Madison, Wis.), or by visual inspection.

One example of a useful algorithm is PILEUP. PILEUP creates a multiplesequence alignment from a group of related sequences using progressive,pairwise alignments to show relationship and percent sequence identity.It also plots a tree or dendogram showing the clustering relationshipsused to create the alignment. PILEUP uses a simplification of theprogressive alignment method of Feng and Doolittle, J. Mol. Evol.35:351-360 (1987). The method used is similar to the method described byHiggins and Sharp, CABIOS 5:151-153 (1989). The program can align up to300 sequences, each of a maximum length of 5,000 nucleotides or aminoacids. The multiple alignment procedure begins with the pairwisealignment of the two most similar sequences, producing a cluster of twoaligned sequences. This cluster is then aligned to the next most relatedsequence or cluster of aligned sequences. Two clusters of sequences arealigned by a simple extension of the pairwise alignment of twoindividual sequences. The final alignment is achieved by a series ofprogressive, pairwise alignments. The program is run by designatingspecific sequences and their amino acid or nucleotide coordinates forregions of sequence comparison and by designating the programparameters. For example, a reference sequence can be compared to othertest sequences to determine the percent sequence identity relationshipusing the following parameters: default gap weight (3.00), default gaplength weight (0.10), and weighted end gaps. Another algorithm that isuseful for generating multiple alignments of sequences is Clustal W(Thompson et al. Nucleic Acids Research 22: 4673-4680, 1994).

Another example of algorithm that is suitable for determining percentsequence identity and sequence similarity is the BLAST algorithm, whichis described in Altschul et al., J. Mol. Biol. 215:403-410 (1990).Software for performing BLAST analyses is publicly available through theNational Center for Biotechnology Information(http://www.ncbi.nlm.nih.gov/). This algorithm involves firstidentifying high scoring sequence pairs (HSPs) by identifying shortwords of length W in the query sequence, which either match or satisfysome positive-valued threshold score T when aligned with a word of thesame length in a database sequence. T is referred to as the neighborhoodword score threshold. These initial neighborhood word hits act as seedsfor initiating searches to find longer HSPs containing them. The wordhits are then extended in both directions along each sequence for as faras the cumulative alignment score can be increased. Cumulative scoresare calculated using, for nucleotide sequences, the parameters M (rewardscore for a pair of matching residues; always >0) and N (penalty scorefor mismatching residues; always <0). For amino acid sequences, ascoring matrix is used to calculate the cumulative score. Extension ofthe word hits in each direction are halted when: the cumulativealignment score falls off by the quantity X from its maximum achievedvalue; the cumulative score goes to zero or below, due to theaccumulation of one or more negative-scoring residue alignments; or theend of either sequence is reached. The BLAST algorithm parameters W, T,and X determine the sensitivity and speed of the alignment. The BLASTNprogram (for nucleotide sequences) uses as defaults a wordlength (W) of11, an expectation (E) of 10, M=5, N=−4, and a comparison of bothstrands. For amino acid sequences, the BLASTP program uses as defaults awordlength (W) of 3, an expectation (E) of 10, and the BLOSUM62 scoringmatrix (see Henikoff and Henikoff, Proc. Natl. Acad. Sci. USA 89:10915,1989).

In addition to calculating percent sequence identity, the BLASTalgorithm also performs a statistical analysis of the similarity betweentwo sequences (see, e.g., Karlin and Altschul, Proc. Nat'l. Acad. Sci.USA 90:5873-5787, 1993). One measure of similarity provided by the BLASTalgorithm is the smallest sum probability (P(N)), which provides anindication of the probability by which a match between two nucleotide oramino acid sequences would occur by chance. For example, a nucleic acidis considered similar to a reference sequence if the smallest sumprobability in a comparison of the test nucleic acid to the referencenucleic acid is less than about 0.1, more preferably less than about0.01, and most preferably less than about 0.001.

A further indication that two nucleic acid sequences or polypeptides aresubstantially identical is that the polypeptide encoded by the firstnucleic acid is immunologically cross reactive with the polypeptideencoded by the second nucleic acid, as described below. Thus, apolypeptide is typically substantially identical to a secondpolypeptide, for example, where the two peptides differ only byconservative substitutions. Another indication that two nucleic acidsequences are substantially identical is that the two moleculeshybridize to each other under stringent conditions, as described herein.

“Substantially pure” or “isolated” means an object species is thepredominant species present (i.e., on a molar basis, more abundant thanany other individual macromolecular species in the composition), and asubstantially purified fraction is a composition wherein the objectspecies comprises at least about 50% (on a molar basis) of allmacromolecular species present. Generally, a substantially purecomposition means that about 80% to 90% or more of the macromolecularspecies present in the composition is the purified species of interest.The object species is purified to essential homogeneity (contaminantspecies cannot be detected in the composition by conventional detectionmethods) if the composition consists essentially of a singlemacromolecular species. Solvent species, small molecules (<500 Daltons),stabilizers (e.g., BSA), and elemental ion species are not consideredmacromolecular species for purposes of this definition. In someembodiments, the conjugates of the invention are substantially pure orisolated. In some embodiments, the conjugates of the invention aresubstantially pure or isolated with respect to the macromolecularstarting materials used in their synthesis. In some embodiments, thepharmaceutical composition of the invention comprises a substantiallypurified or isolated conjugate of a RAP polypeptide and the active agentadmixed with one or more pharmaceutically acceptable excipient.

“Naturally-occurring” as applied to an object refers to the fact thatthe object can be found in nature. For example, a polypeptide orpolynucleotide sequence that is present in an organism (includingviruses) that can be isolated from a source in nature and which has notbeen intentionally modified by man in the laboratory isnaturally-occurring.

“Detecting” refers to determining the presence, absence, or amount of ananalyte in a sample, and can include quantifying the amount of theanalyte in a sample or per cell in a sample.

“Detectable moiety” or a “label” refers to a composition detectable byspectroscopic, photochemical, biochemical, immunochemical, or chemicalmeans. For example, useful labels include ³²P, ³⁵S, fluorescent dyes,electron-dense reagents, enzymes (e.g., as commonly used in an ELISA),biotin-streptavidin, dioxigenin, haptens and proteins for which antiseraor monoclonal antibodies are available, or nucleic acid molecules with asequence complementary to a target. The detectable moiety oftengenerates a measurable signal, such as a radioactive, chromogenic, orfluorescent signal, that can be used to quantitate the amount of bounddetectable moiety in a sample. The detectable moiety can be incorporatedin or attached to a primer or probe either covalently, or through ionic,van der Waals or hydrogen bonds, e.g., incorporation of radioactivenucleotides, or biotinylated nucleotides that are recognized bystreptavadin. The detectable moiety may be directly or indirectlydetectable. Indirect detection can involve the binding of a seconddirectly or indirectly detectable moiety to the detectable moiety. Forexample, the detectable moiety can be the ligand of a binding partner,such as biotin, which is a binding partner for streptavadin, or anucleotide sequence, which is the binding partner for a complementarysequence, to which it can specifically hybridize. The binding partnermay itself be directly detectable, for example, an antibody may beitself labeled with a fluorescent molecule. The binding partner also maybe indirectly detectable, for example, a nucleic acid having acomplementary nucleotide sequence can be a part of a branched DNAmolecule that is in turn detectable through hybridization with otherlabeled nucleic acid molecules. (See, e.g., PD. Fahrlander and A.Klausner, Bio/Technology (1988) 6:1165.) Quantitation of the signal isachieved by, e.g., scintillation counting, densitometry, or flowcytometry.

“Linker” refers to a molecule that joins two other molecules, eithercovalently, or through ionic, van der Waals or hydrogen bonds, e.g., anucleic acid molecule that hybridizes to one complementary sequence atthe 5′ end and to another complementary sequence at the 3′ end, thusjoining two non-complementary sequences.

II. MEGALIN

Megalin, also referred to as LRP2 is a large (600 kDa), is a member ofthe LRP family of receptors (Hussain et al. Annu Rev Nutr., 19:141-721999; Christensen and Birn Am. J. Physiol. Renal. Physiol.,280:F562-573, 2001). Like all members of the LRP family, megalin bindsRAP with high affinity (Czekay et al., Mol. Biol. Cell. 8(3):517-32,1997). Unique among the LRP family, however, megalin is expressed onlyon the apical surface of a restricted set of epithelial cell layers,including those in the kidney proximal tubule, the thyroid, theepididymis, the alveolae and the ciliary body of the eye (Zheng et al. JHistochem Cytochem., 42(4):531-42, 1994). Megalin is also expressed onthe luminal surface of the brain capillary endothelium, a classicalsquamous epithelial cell layer (Chun, et al. Exp Neurol.,157(1):194-201, 1999). Megalin on the brain capillary endothelium hasbeen previously demonstrated to mediate transcytosis of one of itsligands, apoJ, across the blood-brain barrier in vitro (Zlokovic et al.,Proc. Nat'l Acad. Sci., USA 93(9):4229-34 1996; Zlokovic Life Sci.,59(18):1483-97, 1996). Apical-to-basolateral transcytosis of ligands bymegalin has also been documented in the kidney and thyroid (Marino etal. J Am Soc Nephrol., 12(4):637-48, 2001; Marino et al., Thyroid,11(1):47-56, 2001).

In the present application it is shown that megalin mediates thetranscytosis of RAP across tight MDCK cell layers. This application forthe first time shows that it is megalin rather than LRP1 that mediatesthe transcytosis of RAP and other ligands across such cell layers. Giventhis finding, it is contemplated that the use of any and all megalinligands will be excellent candidates for mediating the delivery ofactive agents through targeted delivery in the kidney, thyroid,epididymis, eye and brain cells. Thus, in particular embodiments, whileit is remains desirable to use other LRP family members to mediatetranscytosis of an active agent across the BBB, in particularlypreferred embodiments, such transcytosis is mediated through theconjugation of the active agent to a megalin ligand.

Thus, the present application contemplates that ligands with enhancedspecificity for megalin over LRP1 will be particularly useful as vectorsfor the transport of proteins and small molecules from blood-to-brain.In certain embodiments, the ligands optionally exclude ApoJ. Thisadvantage accrues from avoiding LRP1-mediated clearance in the liver,increasing serum residence time and, consequently, brain influx.

III. OTHER LRP RECEPTORS

While megalin is the preferred receptor through which active agenttranscytosis is achieved, it is contemplated that other LRP receptorswill nonetheless be useful for effecting such transcytosis. “LRP” refersto members of the low-density lipoprotein receptor family including thelow-density lipoprotein receptor-related protein 1 (LRP1). LRP1 is alarge protein of 4525 amino acids (600 kDa), which is cleaved by furinto produce two subunits of 515-(alpha) kD and 85-(B) kDa that remainnon-covalently bound. LRP is expressed on most tissue types. Othermembers of the low-density lipoprotein (LDL) receptor family includeLDL-R (132 kDa); LRP/LRP1 and LRP1B (600 kDa); Megalin ((LRP2), 600kDa); VLDL-R (130 kDa); ER-2 (LRP-8, 130 kDa); Mosaic LDL-R (LR11, 250KDa); and other members such as LRP3, LRP6, and LRP-7. Characteristicfeatures of the family include cell-surface expression; extracellularligand binding domain repeats (DxSDE); requirement of Ca++ for ligandbinding; recognition of RAP and ApoE; EGF precursor homology domainrepeats (YWTD); single membrane spanning region; internalization signalsin the cytoplasmic domain (FDNPXY); and receptor mediated endocytosis ofvarious ligands. Some members of the family, including LRP1 and VLDLR,participate in signal transduction pathways.

LRP ligands refer to a number of molecules that are known to bind LRP.These molecules include, for instance, lactoferrin, RAP, lipoproteinlipase, ApoE, Factor VIII, beta-amyloid precursor,alpha-2-macroglobulin, thrombospondin 2 MMP-2 (matrixmetalloproteinase-2), MPP-9-TIMP-1 (tissue inhibitor of matrixmetalloproteinase-1); uPA (urokinase plasminogen activator):PAI-I(plasminogen activator inhibitor-1):uPAR (uPA receptor); and tPA (tissueplasminogen activator):PAI-1:uPAR.

LRP1 is believed to be a multifunctional receptor with clustering ofcysteine-rich type repeats. A binding repeat, resembling those found inthe LDL receptor, is the molecular principle for the ability to bind avariety of ligands that were previously thought to be unrelated. Theseinclude the ligands described in the previous paragraph in addition to:pseudomonas exotoxin A, human rhinovirus, lactoferrin and the so-calledreceptor associated protein (RAP). See, Meilinger et al., FEBS Lett,360:70-74 (1995). LRP1 is has the GenBank Accession No.: X 13916 andSwissProt Primary Accession No.: Q07954. Alternative names for the LRP1gene/protein include: Low-density lipoprotein receptor-related protein 1[precursor], LRP, Alpha-2-macroglobulin receptor, A2MR, Apolipoprotein Ereceptor, ApoER, CD91, LRP1 or A2MR.

Members of the LRP family are well expressed on capillary endotheliumand on CNS cell types including neurons and astrocytes (e.g., LDLreceptor, Megalin, LRP). LRP receptors endocytose bound ligand and havebeen demonstrated to transcytose ligands across polarized epithelialcells in the kidney, thyroid and across capillary endothelial cells inthe brain. LRP therefore comprises a pool of compositionally andfunctionally related receptors expressed at different levels indifferent tissues. In some embodiments, this invention uses RAP, whichbinds and thereby targets members of this pool of related receptors (andparticularly cells, tissues, and organs expressing a member of thispool). Examples include the VLDLR on muscle tissue, LRP1B on neuronaltissue, Megalin on both kidney and neuronal tissue and LRP1 on vascularsmooth muscle tissue.

IV. RAP AND OTHER MEGALIN LIGANDS

In specific embodiments of the present invention chimeric molecules aremade, which comprise first portion that is a megalin ligand or a megalinbinding fragment thereof and a second portion that is an active agentwhose delivery will be mediated through the binding of the megalinligand (or fragment thereof) to megalin. In preferred embodiments, theligand selected to form part of these chimeric molecules will be onewhich is transcytosed in vivo. “RAP” is a well-known protein of about 39kDa and 323 amino acids and is a specialized chaperone for members ofthe LRP family. It is transcytosed in vivo. RAP inhibits the binding ofligand to members of the LDL-receptor family such as LRP (see Bu andRennke, J. Biol. Chem. 271: 22218-2224 (1996); Willnow et al., J. Biol.Chem. 267: 26172-26180 (1992); Bu and Schwartz, Trends Cell Biol. 8:272-276 (1998); and Herz and Strickland, J. Clin. Invest. 108: 779-784(2001). See also, Bu and Schwartz, Trends Cell Biol. 8: 272-276 (1998).Further characterization of RAP, including the complete amino acidsequence of human RAP (FIG. 15), is found in U.S. Pat. No. 5,474,766which is incorporated herein by reference in its entirety and also withparticularity with respect to the RAP amino acid sequences and fragmentsdisclosed therein. The 28 kDa human C-terminal fragment (FIG. 16) is anextremely active RAP polypeptide and in preferred embodiments of theinvention, the conjugate comprises this fragment as the carrier for theactive agent.

RAP polypeptides include, but are not limited to, RAP, soluble forms ofRAP, cleaved RAP, RAP polypeptide fragments, homologues and analogs ofRAP, and the like. RAP polypeptides that are functional equivalents ofRAP with respect to modulation of LRP receptor binding, transcytosis, orendocytosis can be readily identified by screening for the ability ofthe RAP polypeptide to bind to LRP. In preferred embodiments, the RAPpolypeptide is a homologue of RAP having, for instance, greater than80%, 90% 95%, 98%, or 99% sequence identity with a naturally occurring,native or wild type mammalian RAP amino acid sequence of similar lengthor over a domain of at least 10 amino acids, 25 amino acids, 50 aminoacids, 100 amino acids, or 200 amino acids, 300 amino acids, or theentire length of the RAP polypeptide. RAP polypeptides include allelicvariants of RAP, paralogs and orthologs in human, mouse, rat, chicken,zebrafish, pig, fruit fly, mosquito, and flatworm native RAP, andderivatives, portions, or fragments thereof (Genbank accession numbers:P30533 (human), XP132029 (mouse), Q99068 (rat), CAA05085 (chicken),AAH49517 (zebrafish), AAM90301 (pig), NP649950 (fruit fly), XP313261(mosquito), NP506187 (flatworm). A multiple alignment of amino acidsequences from mouse, rat, chicken zebrafish, fruitfly, mosquito, andflatworm and the consensus sequence is shown in FIG. 14.

The RAP polypeptide can be in the form of acidic or basic salts, or inits neutral form. In addition, individual amino acid residues can bemodified, such as by oxidation or reduction. Moreover, varioussubstitutions, deletions, or additions can be made to the amino acid ornucleic acid sequences, the net effect of which is to retain or improveupon the desired biological activity of RAP. Further characterization ofRAP, including the complete amino acid sequence of RAP, is found in U.S.Pat. No. 5,474,766 which is incorporated herein by reference in itsentirety and also with particularity with respect to the amino acidsequences of the various RAP polypeptides disclosed therein. Due to codedegeneracy, for example, one of ordinary skill in the art would know ofconsiderable variations of the nucleotide sequences encoding the sameamino acid sequence.

Preferred RAP polypeptides share substantial homology with the nativeamino acid sequence of a receptor associated protein (RAP), particularlythe native human sequence (SEQ ID NO:1). In preferred embodiments, theRAP polypeptide is a homologue of RAP having, for instance, greater than80%, 90% 95%, 98%, or 99% sequence identity with a native or wild typemammalian RAP amino acid sequence of similar length or over a domain orcomparison window of at least 10, amino acids, 25 amino acids, 50 aminoacids, 100 amino acids, or 200 amino acids, or 300 amino acids or more.

An especially preferred human or mammalian RAP is isolated RAP or afragment thereof, such as a soluble polypeptide fragment of RAP, whichcontains at least one of the RAP binding sites for LRP. Substantialguidance exists in the art to which portions of RAP are important to itsLRP binding and modulatory activity and which portions may be mutated,altered, or deleted without loss of binding activity (see, Nielsen etal. Proc. Nat. Acad. Sci. USA 94:7521 (1997); and Rall et al. J. Biol.Chem. 273(37):24152, 1998). For instance, RAP's LRP binding function hasbeen mapped by performing direct binding studies on fusion proteinsrepresenting overlapping domains of RAP (see Willnow et al., J. Biol.Chem. 267(36):26172-80, 1992). The RAP binding motifs have also beencharacterized by use of truncated and site-directed RAP mutants (seeMelman et al. J. Biol. Chem. 276(31):29338-29346, 2001). Particular RAPpolypeptide fragments, suitable for use according to the invention,include fragments (defined from RAP N terminus amino acid to RAPC-terminus amino acid position) 1-323 (RAP); 1-319; 1-250; 1-110;91-210; 191-323; 221-323; 1-190; 1-200; and 1-210. Preferred RAPpolypeptides include fragments 1-323 (RAP); 1-319; 191-323; and 1-210. Amodified RAP polypeptide having the C-terminal four amino acid sequencesubstituted by the sequence KDEL is also suitable. A modified RAPpolypeptide in which the C-terminal-four amino acid sequence (HNEL) isdeleted is also suitable. Also preferred are RAP polypeptides fragmentsthat comprise the native sequence of RAP from amino acid 201 to 210.

Other preferred embodiments, comprise a human or mammalian RAPpolypeptide in which the polypeptide comprises the native amino acidsequence of RAP over positions 282-289, 201-210, and 311-319. Mutatedand N-terminus or C-terminus truncated variants of RAP which bind to theLRP receptor are disclosed in Melman et al. (J. Biol. Chem. 276(31):29338-46, 2001) which is incorporated herein by reference in itsentirety and with particularity to these RAP mutated and truncatedvariants. Other preferred RAP polypeptides comprise a native sequence ofRAP between amino acids 85-148 and 178-248. (see Farquhar et al., Proc.Nat. Acad. Sci. USA 91:3161-3162 (1994).

Thus, many references disclose the binding sites and structure activityrelationships for binding of RAP and RAP fragments to the LRP receptor.The skilled artisan can readily adapt a variety of well known techniquesin the art in order to obtain RAP polypeptides that contain a LRPbinding site and are suitable for use as RAP polypeptides according tothe invention. The preferred fragments of RAP are soluble underphysiological conditions. The N-terminus or C-terminus of thesepolypeptides can be shortened as desired, provided that the bindingcapacity for the LRP particle remains intact. The preferred amino acidsequence of RAP corresponds to the human protein. Suitable sequences fora RAP polypeptide can also be derived from the amino acid sequences ofRAP isolated from other mammals or members of the kingdom Animalia.

In order to generate fragments of RAP which contains the LRP bindingsite, isolated native protein may be converted by enzymatic and/orchemical cleavage to generate fragments of the whole protein, forexample by reacting RAP with an enzyme such as papain or trypsin or achemical such as cyanogen bromide. Proteolytically active enzymes orchemicals are preferably selected in order to release the extracellularreceptor region. Fragments that contain the LRP binding site, especiallyfragments that are soluble under physiological conditions, can then beisolated using known methods.

Alternatively, RAP or a fragment of RAP may be expressed in arecombinant bacteria, as described, for example, in Williams et al., J.Biol. Chem. 267:9035-9040 (1992); Wurshawsky et al., J. Biol. Chem.269:3325-3330 (1994); Melman et al. J. Biol. Chem. 276(31): 29338-46(2001).

RAP can be in the form of acidic or basic salts, or in neutral forms. Inaddition, individual amino acid residues can be modified, such as byoxidation or reduction. Moreover, various substitutions, deletions, oradditions can be made to the amino acid or nucleic acid sequences, thenet effect of which is to retain or improve upon the desired biologicalactivity of RAP. Due to code degeneracy, for example, there may beconsiderable variation in nucleotide sequences encoding the same aminoacid sequence.

A RAP fragment as used herein includes, but not limited to, any portionof RAP or its biologically equivalent analogs that contains a sufficientportion of the ligand to enable it to bind to LRP and to betranscytosed, transported across the blood-brain barrier; or thatotherwise retains or improves upon the desired LRP mediated carrieractivities of the ligand. FIG. 15 shows the amino acid sequence of humanRAP. FIG. 16 shows the amino acid sequence of the 28 kd RAP polypeptide.

In addition to RAP, other megalin ligands may be used to facilitate thetransport of active agents through transcytosis. Megalin ligands otherthan RAP include, for example, include thyroglobulin (Zheng et al.,Endocrinol., 139:1462-1465, 1998; for exemplary sequence see e.g.,GenBank Acc. No. NP_(—)003226 and Collins et al., J. Clin. Endocrinol.Metab. 88 (10), 5039-5042, 2003), lipoprotein lipase (Kounnas et al., J.Biol. Chem., 268:14176-14181, 1993; for exemplary sequence see e.g.,GenBank Acc. No. AAP35372) lactoferrin (Willnow et al., J. Biol. Chem.,267: 26172-26180, 1992; for exemplary sequence see e.g., GenBank Acc.No. AAN11304 from Velliyagounder et al., Infect. Immun. 71 (11),6141-6147, 2003), apolipoprotein J/clusterin (Kounnas et al., J. Biol.Chem., 270:13070-13075, 1995; for exemplary sequence see e.g., GenBankAcc. No. NP_(—)001822 and NP_(—)976084 and Ota et al., Nat. Genet., Nat.Genet. 36 (1), 40-45 (2004); Ota et al., Int. J. Cancer 108 (1), 23-30,2004), apolipoprotein B (Stefansson et al., J. Biol. Chem.,270:19417-19421, 1995; for exemplary sequence see e.g., GenBank Acc. No.AAP72970), apolipoprotein E (Willnow et al., J. Biol. Chem., 267:26172-26180, 1992; for exemplary sequence see e.g., GenBank Acc. No.NP_(—)000032 and Hirono et al., J Neuropsychiatry Clin Neurosci 15 (3),354-358, 2003), tissue type plasminogen activator (Willnow et al., J.Biol. Chem., 267: 26172-26180, 1992; for exemplary sequence see e.g.,GenBank Acc. No. P00750 and Pennica et al., Nature 301 (5897), 214-221(1983), uPA (Moestrup et al., J. Clin. Invest., 102:902-909, 1998; forexemplary sequence see e.g., GenBank Acc. No. NP_(—)002649 and Tran etal., Mol. Cell. Biol. 23 (20), 7177-7188 (2003), PAI-1 (Stefansson etal., J. Cell. Sci., 108:2361-2368, 1995; for exemplary sequence seee.g., GenBank Acc. No. NP_(—)000593 and He et al., Biochem. Biophys.Res. Commun. 310 (3), 878-883, 2003), vitamin D-binding protein (DBP;Nykjaer et al., Cell 96:507-515, 1999; for exemplary sequence see e.g.,GenBank Acc. No. AAA19662 and also, Yang et al., Gene 54 (2-3), 285-290,1987), vitamin A/retinol-binding protein (RBP; Christensen et al., J.Am. Soc. Nephrol., 10:685-695, 1999; for exemplary sequence see e.g.,GenBank Acc. No. AAA59188), β2-microglobin (Orlando et al., J. Am. Soc.Nephrol., 9:1759-1766, 1998; AAA51811 and AAH64910), al-microglobulin(Orlando et al., J. Am. Soc. Nephrol., 9:1759-1766, 1998; AAH41593 andCAA38585), vitamin B12/cobalamin plasma carrier protein, transcobalamin(TC)-B12, PTH, insulin (Orlando et al., J. Am. Soc. Nephrol.,9:1759-1766, 1998), EGF (Orlando et al., J. Am. Soc. Nephrol.,9:1759-1766, 1998), prolactin (Orlando et al., J. Am. Soc. Nephrol.,9:1759-1766, 1998), albumin, apo H (for exemplary sequence see e.g.,GenBank Acc. No. see P02749 see also, Gene 108 (2), 293-298, 1991),transthyretin (for exemplary sequence see e.g., GenBank Acc. No. seeNP_(—)000362), lysozyme (Orlando et al., J. Am. Soc. Nephrol.,9:1759-1766, 1998; see e.g., CAA00878 and EP 0222366-A), cytochrome-c(Orlando et al., J. Am. Soc. Nephrol., 9:1759-1766, 1998), α-amylase,and Ca2+, and aprotinin. For a detailed review of the structure,function and expression patterns of megalin those skilled in the art arereferred to Christensen and Birn (Am. J. Physiol. Renal. Physiol.,280:F562-573, 2001.) It should be noted tat the GenBank Acc. No. provideexemplary sequences of these proteins known to those of skill in theart. There are numerous other such sequences that also are know to thoseof skill that may be used in the conjugates herein either as thewild-type sequences or as modified sequences (e.g., fragments,conservative variants and the like).

Any of the above megalin ligands will be used for the delivery of activeagents via transcytosis. In such embodiment, the megalin ligand isconjugated to the active agent of interest using techniques known tothose of skill in the art. In preferred embodiments, it is contemplatedthat such ligands may be further modified to increase their bindingaffinity to megalin. Such modified ligands will be particularly usefuldelivery vehicles for transcytosis across any cell which expresses amegalin receptor. In other preferred embodiments, it is contemplatedthat the megalin ligands may be modified such that the ligands have agreater binding affinity for megalin than for LRP1. Such ligands will beparticularly useful as vectors for the transport of proteins and smallmolecules across the blood-to-brain barrier. This advantage accrues fromavoiding LRP1-mediated clearance of the active agents in the in theliver mediated through the LRP1 receptor on liver cells, therebyincreasing serum residence time and, consequently, brain influx of theactive agent.

V. CONJUGATES OF MEGALIN-BINDING MOIETY AND ACTIVE AGENT

Throughout the specification, Applicants refer to a megalin-bindingmoiety. Typically, such a moiety is a natural megalin binding ligandsuch as the ligands described herein above. In other embodiments, themoiety is a modified such ligand. In still further embodiments, themegalin-binding moiety may be all or part of an antibody that isimmunoreactive with megalin and therefore recognizes megalin. In thepresent invention, the megalin-binding moiety is conjugated to an agentthat is to be delivered to a given target, e.g., to the brain. Theinstant specification refers to megalin ligand-active agent conjugate.It should be understood that the megalin ligand may include any of theaforementioned megalin-binding entities.

A “megalin ligand-conjugate”, “ligand-polypeptide conjugate” “chimericmolecule comprising a megalin ligand conjugated to an active agent” eachrefers to a compound comprising a ligand of megalin, or amegalin-binding fragment thereof, attached to an active agent. As usedherein, the term “conjugated” means that the therapeutic agent(s) andmegalin polypeptide are physically linked by, for example, by covalentchemical bonds, physical forces such van der Waals or hydrophobicinteractions, encapsulation, embedding, or combinations thereof. Inpreferred embodiments, the therapeutic agent(s) and the megalin ligandpolypeptide are physically linked by covalent chemical bonds. As such,preferred chemotherapeutic agents contain a functional group such as analcohol, acid, carbonyl, thiol or amine group to be used in theconjugation to megalin ligand or fragment thereof. In preferredembodiments, the megalin ligand is RAP or a RAP polypeptide. Adriamycinis in the amine class and there is also the possibility to link throughthe carbonyl as well. Paclitaxel is in the alcohol class.Chemotherapeutic agents without suitable conjugation groups may befurther modified to add such a group. All these compounds arecontemplated in this invention. In the case of multiple therapeuticagents, a combination of various conjugations can be used.

In some embodiments, a covalent chemical bond that may be either direct(no intervening atoms) or indirect (through a linker e.g., a chain ofcovalently linked atoms) joins the megalin ligand and the active agent.In preferred embodiments, the megalin ligand and the active agent moietyof the conjugate are directly linked by covalent bonds between an atomof the megalin ligand and an atom of the active agent. In some preferredembodiments, the megalin binding moiety is connected to the active agentmoiety of the compound according to the invention by a linker thatcomprises a covalent bond or a peptide of virtually any amino acidsequence or any molecule or atoms capable of connecting the megalinligand or megalin binding fragment thereof to the active agent.

In some embodiments, the linker comprises a chain of atoms from 1 toabout 30 atoms or longer, 2 to 5 atoms, 2 to 10 atoms, 5 to 10 atoms, or10 to 20 atoms long. In some embodiments, the chain atoms are all carbonatoms. In some embodiments, the chain atoms are selected from the groupconsisting of C, O, N, and S. Chain atoms and linkers may be selectedaccording to their expected solubility (hydrophilicity) so as to providea more soluble conjugate. In some embodiments, the linker provides afunctional group that is subject to enzymatic attack in a lysosome. Insome embodiments, the linker provides a functional group which issubject to attack by an enzyme found in the target tissue or organ andwhich upon attack or hydrolysis severs the link between the active agentand the megalin ligand. In some embodiments, the linker provides afunctional group that is subject to hydrolysis under the conditionsfound at the target site (e.g., low pH of a lysosome). A linker maycontain one or more such functional groups. In some embodiments, thelength of the linker is long enough to reduce the potential for sterichindrance (when an active agent is large) between one or both of themegalin ligand binding site and the active agent active binding site.

If the linker is a covalent bond or a peptide and the active agent is apolypeptide, then the entire conjugate can be a fusion protein. Suchfusion proteins may be produced by recombinant genetic engineeringmethods known to one of ordinary skill in the art. In some embodiments,the megalin ligand portion of the conjugate is formulated to rapidlydegrade to release the active compound. In other embodiments, the linkeris subject to cleavage under intracellular, or more preferably,lysosomal environmental conditions to release or separate the activeagent portion from the megalin ligand polypeptide portion.

The conjugate can comprise one or more active agents linked to the samemegalin ligand. For example, conjugation reactions may conjugate from 1to 5, about 5, about 1 to 10, about 5 to 10, about 10 to 20, about 20 to30, or 30 or more molecules of an active agent to the megalin ligandpolypeptide. These formulations can be employed as mixtures, or they maybe purified into specific stoichiometric formulations. Those skilled inthe art are able to determine which format and which stoichiometricratio is preferred. Further, more than one type of active agent may belinked to the megalin ligand polypeptide where delivery of more than onetype of an agent to a target site or compartment is desired. A pluralityof active agent species may be attached to the same megalin ligandpolypeptide e.g., adriamycin-cisplatinum RAP polypeptide (or othermegalin ligand) conjugates. Thus, the conjugates may consist of a rangeof stoichiometric ratios and incorporate more than one type of activeagent. These, too, may be separated into purified mixtures or they maybe employed in aggregate.

The megalin ligand or fragment thereof conjugate according to theinvention may be modified as desired to enhance its stability orpharmacokinetic properties (e.g., PEGylation). Suitable linkers andtheir functional groups for conjugating megalin ligand polypeptides andan active agent, and the synthetic chemical methods readily adaptablefor preparing such, are described in U.S. Patent Application No.60/395,762 which is assigned to the same assignee as the presentapplication and herein incorporated by reference in its entirety.

The synthesis of these conjugates is efficient and convenient, producinghigh yields and drugs with enhanced aqueous solubility.

VI. ACTIVE AGENTS

Active agents according to the invention include agents that can affecta biological process. Particularly preferred active agents for use inthe compounds compositions and methods of the invention are therapeuticagents, including drugs and diagnostic agents. The term “drug” or“therapeutic agent” refers to an active agent that has a pharmacologicalactivity or benefits health when administered in a therapeuticallyeffective amount. Particularly preferred agents are naturally occurringbiological agents (e.g., enzymes, proteins, polynucleotides, antibodies,polypeptides). In some embodiments, the active agent conjugated to amegalin ligand or a megalin-binding fragment thereof (e.g., in certainpreferred embodiments, a RAP or RAP polypeptide) is a molecule, as wellas any binding portion or fragment thereof, that is capable ofmodulating a biological process in a living host. Examples of drugs ortherapeutic agents include substances that are used in the prevention,diagnosis, alleviation, treatment or cure of a disease or condition. Itis particularly contemplated that the agent is not an agent that causesa disease. Specifically, the agent is not amyloid β protein.

A. Protein Active Agents

The active agent can be a non-protein or a protein. The active agent canbe a protein or enzyme or any fragment of such that still retains some,substantially all, or all of the therapeutic or biological activity ofthe protein or enzyme. In some embodiments, the protein or enzyme is onethat, if not expressed or produced or if substantially reduced inexpression or production, would give rise to a disease, including butnot limited to, lysosomal storage diseases. Preferably, the protein orenzyme is derived or obtained from a human or mouse.

In preferred embodiments of the invention, when the active agentconjugated to RAP or RAP polypeptide is a protein or enzyme, or fragmentthereof possessing a biological activity of the protein or enzyme, theactive agent has an amino acid sequence identical to the amino acidsequence to the corresponding portion of the human or mammalian proteinor enzyme. In other embodiments, the active agent moiety of theconjugate is a protein or enzyme native to the species of the human ormammal. In other embodiments, the protein or enzyme, or fragmentthereof, is substantially homologous (i.e., at least 80%, 85%, 90%, 95%,more preferably 98%, or most preferably 99% identical in amino acidsequence over a length of at least 10, 25, 50, 100, 150, or 200 aminoacids, or the entire length of the active agent) to a native sequence ofthe corresponding human or mammal protein or enzyme.

If the compound is a protein, the compound can be an enzyme, or anyfragment of an enzyme that still retains some, substantially all, or allof the activity of the enzyme. Preferably, in the treatment of lysosomalstorage diseases, the enzyme is an enzyme that is found in a cell thatif not expressed or produced or is substantially reduced in expressionor production would give rise to a lysosomal storage disease.Preferably, the enzyme is derived or obtained from a human or mouse.Preferably, the enzyme is a lysosomal storage enzyme, such asα-L-iduronidase, iduronate-2-sulfatase, heparan N-sulfatase,α-N-acetylglucosaminidase, arylsulfatase A, galactosylceramidase,acid-alpha-glucosidase, tripeptidyl peptidase, hexosaminidase alpha,acid sphingomyelinase, β-galactosidase, or any other lysosomal storageenzyme.

In some embodiments, therefore, in the treatment of human LysosomalStorage Diseases (LSDs), the megalin ligand-active agent conjugatecomprises an active agent protein or enzyme that is deficient in thelysosomes of a subject or patient to be treated. Such enzymes, includefor example, alpha-L-iduronidase, iduronate-2-sulfatase, heparanN-sulfatase, alpha-N-acetylglucosaminidase, Arylsulfatase A,Galactosylceramidase, acid-alpha-glucosidase, thioesterase,hexosaminidase A, Acid Spingomyelinase, alpha-galactosidase, or anyother lysosomal storage enzyme. A table of lysosomal storage diseasesand the proteins deficient therein, which are useful as active agents,follows:

Lysosomal Storage Disease Protein deficiency Mucopolysaccharidosis typeI L-Iduronidase Mucopolysaccharidosis type II Iduronate-2-sulfataseHunter syndrome Mucopolysaccharidosis type IIIA Heparan-N-sulfataseSanfilippo syndrome Mucopolysaccharidosis type IIIBα-N-Acetylglucosaminidase Sanfilippo syndrome Mucopolysaccharidosis typeIIIC AcetylCoA:N-acetyltransferase Sanfilippo syndromeMucopolysaccharidosis type IIID N-Acetylglucosamine 6-sulfataseSanfilippo syndrome Mucopolysaccharidosis type IVA Galactose 6-sulfataseMorquio syndrome Mucopolysaccharidosis type IVB β-Galactosidase Morquiosyndrome Mucopolysaccharidosis type VI N-Acetylgalactosamine 4-sulfataseMucopolysaccharidosis type VII Sly β-Glucuronidase syndromeMucopolysaccharidosis type IX hyaluronoglucosaminidaseAspartylglucosaminuria Aspartylglucosaminidase Cholesterol ester storagedisease/ Acid lipase Wolman disease Cystinosis Cystine transporter Danondisease Lamp-2 Fabry disease α-Galactosidase A FarberLipogranulomatosis/Farber Acid ceramidase disease Fucosidosisα-L-Fucosidase Galactosialidosis types I/II Protective protein Gaucherdisease types I/IIIII Gaucher Glucocerebrosidase (β-glucosidase) diseaseGloboid cell leukodystrophy/Krabbe Galactocerebrosidase disease Glycogenstorage disease II/Pompe α-Glucosidase disease GM1-Gangliosidosis typesI/II/III β-Galactosidase GM2-Gangliosidosis type I/Tay β-HexosaminidaseA Sachs disease GM2-Gangliosidosis type II Sandhoff β-Hexosaminidase Adisease GM2-Gangliosidosis GM2-activator deficiency α-Mannosidosis typesI/II α-D-Mannosidase β-Mannosidosis β-D-Mannosidase Metachromaticleukodystrophy Arylsulfatase A Metachromatic leukodystrophy Saposin BMucolipidosis type I/Sialidosis Neuraminidase types I/II Mucolipidosistypes II/III I-cell Phosphotransferase disease Mucolipidosis type IIICpseudo- Phosphotransferase γ-subunit Hurler polydystrophy Multiplesulfatase deficiency Multiple sulfatases Neuronal Ceroid Lipofuscinosis,Palmitoyl protein thioesterase CLN1 Batten disease Neuronal CeroidLipofuscinosis, Tripeptidyl peptidase I CLN2 Batten disease Niemann-Pickdisease types A/B Acid sphingomyelinase Niemann-Pick diseaseNiemann-Pick disease type C1 Cholesterol trafficking Niemann-Pickdisease Niemann-Pick disease type C2 Cholesterol traffickingNiemann-Pick disease Pycnodysostosis Cathepsin K Schindler disease typesI/II Schindler α-Galactosidase B disease Sialic acid storage diseasesialic acid transporter

Thus, the lysosomal storage diseases that can be treated or preventedusing the methods of the present invention include, but are not limitedto, Mucopolysaccharidosis I (MPS I), MPS II, MPS IIIA, MPS IIIB,Metachromatic Leukodystrophy (MLD), Krabbe, Pompe, CeroidLipofuscinosis, Tay-Sachs, Niemann-Pick A and B, and other lysosomaldiseases.

Thus, per the above table, for each disease the conjugated agent wouldpreferably comprise a specific active agent enzyme deficient in thedisease. For instance, for methods involving MPS I, the preferredcompound or enzyme is α-L-iduronidase. For methods involving MPS II, thepreferred compound or enzyme is iduronate-2-sulfatase. For methodsinvolving MPS IIIA, the preferred compound or enzyme is heparanN-sulfatase. For methods involving MPS IIIB, the preferred compound orenzyme is α-N-acetylglucosaminidase. For methods involving MetachromaticLeukodystropy (MLD), the preferred compound or enzyme is arylsulfataseA. For methods involving Krabbe, the preferred compound or enzyme isgalactosylceramidase. For methods involving Pompe, the preferredcompound or enzyme is acid α-glucosidase. For methods involving CLN, thepreferred compound or enzyme is tripeptidyl peptidase. For methodsinvolving Tay-Sachs, the preferred compound or enzyme is hexosaminidasealpha. For methods involving Niemann-Pick A and B the preferred compoundor enzyme is acid sphingomyelinase.

The megalin ligand-active agent conjugate can comprise one or moreactive agent moieties (e.g., 1 to 10 or 1 to 4 or 2 to 3 moieties)linked to the megalin ligand or megalin-binding fragment thereof. Forexample, conjugation reactions may conjugate from 1 to 4 or moremolecules of alpha-L-iduronidase to a single megalin ligand, such as aRAP polypeptide molecule. These formulations can be employed asmixtures, or they may be purified into specific megalin ligandpolypeptide-agent stoichiometric formulations. Those skilled in the artare able to determine which format and which stoichiometric ratio ispreferred. Further, one or more different active agents may be linked toany given molecule of a megalin ligand or a megalin-binding fragment ofa megalin ligand to facilitate a more complete degradation of the storedsubstrates. These megalin ligand conjugated agents may consist of arange of stoichiometric ratios. These, too, may be separated intopurified mixtures or they may be employed in aggregate. It may be theorder of megalin-binding moiety and the LSD in the fusion is importantfor the ability of megalin binding moiety to bind to megalin. Therefore,in preferred embodiments, the megalin-binding moiety is locatedN-terminally to the LSD enzyme coding sequence. In specific embodiments,it is contemplated that the conjugates of the invention comprise a RAPencoding sequence located N-terminally to the LSD enzyme codingsequence.

The megalin ligand conjugated active agents can enter or be transportedinto or end up residing in the lysosomes of a cell within or without theCNS. The rate of passage of the conjugated agent can be modulated by anycompound or protein that can modulate megalin binding activity. Inpreferred embodiments, the megalin binding affinity of the conjugate ishigher than the LRP1 binding affinity. The cell can be from any tissueor organ system affected by the lysosomal storage disease. The cell canbe, for instance, an endothelial, epithelial, muscle, heart, bone, lung,fat, kidney, or liver cell. In some embodiments, the cell is preferablya cell found within the BBB. In some embodiments, the cell is a neuronor a brain cell. In other embodiments, the cell is a cell of theperiphery or one that is not isolated from the general circulation by anendothelium such as that of the BBB.

B. Drug Active Agents

Generally, the drug active agent may be of any size. Preferred drugs aresmall organic molecules that are capable of binding to the target ofinterest. A drug moiety of the conjugate, when a small molecule,generally has a molecular weight of at least about 50 D, usually atleast about 100 D, where the molecular weight may be as high as 500 D orhigher, but will usually not exceed about 2000 D.

The drug moiety is capable of interacting with a target in the host intowhich the conjugate is administered during practice of the subjectmethods. The target may be a number of different types of naturallyoccurring structures, where targets of interest include bothintracellular and extracellular targets, where such targets may beproteins, phospholipids, nucleic acids and the like, where proteins areof particular interest. Specific proteinaceous targets of interestinclude, without limitation, enzymes, e.g., kinases, phosphatases,reductases, cyclooxygenases, proteases and the like, targets comprisingdomains involved in protein-protein interactions, such as the SH2, SH3,PTB and PDZ domains, structural proteins, e.g., actin, tubulin, etc.,membrane receptors, immunoglobulins, e.g., IgE, cell adhesion receptors,such as integrins, etc., ion channels, transmembrane pumps,transcription factors, signaling proteins, and the like.

In some embodiments, the active agent or drug has a hydroxyl or an aminogroup for reacting with the isocyanate reagent or the active agent ischemically modified to introduce a hydroxyl or an amino group forreacting with the isocyanate reagent.

In some embodiments, the active agent or drug comprises a region thatmay be modified and/or participate in covalent linkage, preferably,without loss of the desired biological activity of the active agent. Thedrug moieties often comprise cyclical carbon or heterocyclic structuresand/or aromatic or polyaromatic structures substituted with one or moreof the above functional groups. Also of interest as drug moieties arestructures found among biomolecules, proteins, enzymes, polysaccharides,and polynucleic acids, including peptides, saccharides, fatty acids,steroids, purines, pyrimidines, derivatives, structural analogs orcombinations thereof.

Suitable active agents include, but are not limited to,psychopharmacological agents, such as (1) central nervous systemdepressants, e.g., general anesthetics (barbiturates, benzodiazepines,steroids, cyclohexanone derivatives, and miscellaneous agents),sedative-hypnotics (benzodiazepines, barbiturates, piperidinediones andtriones, quinazoline derivatives, carbamates, aldehydes and derivatives,amides, acyclic ureides, benzazepines and related drugs, phenothiazines,etc.), central voluntary muscle tone modifying drugs (anticonvulsants,such as hydantoins, barbiturates, oxazolidinediones, succinimides,acylureides, glutarimides, benzodiazepines, secondary and tertiaryalcohols, dibenzazepine derivatives, valproic acid and derivatives, GABAanalogs, etc.), analgesics (morphine and derivatives, oripavinederivatives, morphinan derivatives, phenylpiperidines,2,6-methane-3-benzazocaine derivatives, diphenylpropylamines andisosteres, salicylates, p-aminophenol derivatives, 5-pyrazolonederivatives, arylacetic acid derivatives, fenamates and isosteres, etc.)and antiemetics (anticholinergics, antihistamines, antidopaminergics,etc.), (2) central nervous system stimulants, e.g., analeptics(respiratory stimulants, convulsant stimulants, psychomotor stimulants),narcotic antagonists (morphine derivatives, oripavine derivatives,2,6-methane-3-benzoxacine derivatives, morphinan derivatives)nootropics, (3) psychopharmacologicals, e.g., anxiolytic sedatives(benzodiazepines, propanediol carbamates) antipsychotics (phenothiazinederivatives, thioxanthine derivatives, other tricyclic compounds,butyrophenone derivatives and isosteres, diphenylbutylamine derivatives,substituted benzamides, arylpiperazine derivatives, indole derivatives,etc.), antidepressants (tricyclic compounds, MAO inhibitors, etc.), (4)respiratory tract drugs, e.g., central antitussives (opium alkaloids andtheir derivatives); pharmacodynamic agents, such as (1) peripheralnervous system drugs, e.g., local anesthetics (ester derivatives, amidederivatives), (2) drugs acting at synaptic or neuroeffector junctionalsites, e.g., cholinergic agents, cholinergic blocking agents,neuromuscular blocking agents, adrenergic agents, antiadrenergic agents,(3) smooth muscle active drugs, e.g., spasmolytics (anticholinergics,musculotropic spasmolytics), vasodilators, smooth muscle stimulants, (4)histamines and antihistamines, e.g., histamine and derivative thereof(betazole), antihistamines (H1-antagonists, H2-antagonists), histaminemetabolism drugs, (5) cardiovascular drugs, e.g., cardiotonics (plantextracts, butenolides, pentadienolids, alkaloids from erythrophleumspecies, ionophores, adrenoceptor stimulants, etc), antiarrhythmicdrugs, antihypertensive agents, antilipidemic agents (clofibric acidderivatives, nicotinic acid derivatives, hormones and analogs,antibiotics, salicylic acid and derivatives), antivaricose drugs,hemostyptics, (6) blood and hemopoietic system drugs, e.g., antianemiadrugs, blood coagulation drugs (hemostatics, anticoagulants,antithrombotics, thrombolytics, blood proteins and their fractions), (7)gastrointestinal tract drugs, e.g., digestants (stomachics,choleretics), antiulcer drugs, antidiarrheal agents, (8) locally actingdrugs; chemotherapeutic agents, such as (1) anti-infective agents, e.g.,ectoparasiticides (chlorinated hydrocarbons, pyrethins, sulfuratedcompounds), anthelmintics, antiprotozoal agents, antimalarial agents,antiamebic agents, antileiscmanial drugs, antitrichomonal agents,antitrypanosomal agents, sulfonamides, antimycobacterial drugs,antiviral chemotherapeutics, etc., and (2) cytostatics, i.e.,antineoplastic agents or cytotoxic drugs, such as alkylating agents,e.g., Mechlorethamine hydrochloride (Nitrogen Mustard, Mustargen, HN2),Cyclophosphamide (Cytovan, Endoxana), Ifosfamide (IFEX), Chlorambucil(Leukeran), Melphalan (Phenylalanine Mustard, L-sarcolysin, Alkeran,L-PAM), Busulfan (Myleran), Thiotepa (Triethylenethiophosphoramide),Carmustine (BiCNU, BCNU), Lomustine (CeeNU, CCNU), Streptozocin(Zanosar) and the like; plant alkaloids, e.g., Vincristine (Oncovin),Vinblastine (Velban, Velbe), Paclitaxel (Taxol), and the like;antimetabolites, e.g., Methotrexate (MTX), Mercaptopurine (Purinethol,6-MP), Thioguanine (6-TG), Fluorouracil (5-FU), Cytarabine (Cytosar-U,Ara-C), Azacitidine (Mylosar, 5-AZA) and the like; antibiotics, e.g.,Dactinomycin (Actinomycin D, Cosmegen), Doxorubicin (Adriamycin),Daunorubicin (duanomycin, Cerubidine), Idarubicin (Idamycin), Bleomycin(Blenoxane), Picamycin (Mithramycin, Mithracin), Mitomycin (Mutamycin)and the like, and other anticellular proliferative agents, e.g.,Hydroxyurea (Hydrea), Procarbazine (Mutalane), Dacarbazine (DTIC-Dome),Cisplatin (Platinol) Carboplatin (Paraplatin), Asparaginase (Elspar)Etoposide (VePesid, VP-16-213), Amsarcrine (AMSA, m-AMSA), Mitotane(Lysodren), Mitoxantrone (Novatrone), and the like. Preferredchemotherapeutic agents are those, which in the free form, demonstrateunacceptable systemic toxicity at desired doses. The general systemictoxicity associated with therapeutic levels of such agents may bereduced by their linkage to RAP or a RAP polypeptide or other megalinligand. Particularly preferred are cardiotoxic compounds that are usefultherapeutics but are dose limited by cardiotoxicity. A classic exampleis adriamycin (also known as doxorubicin) and its analogs, such asdaunorubicin. Linking RAP or a RAP polypeptide or another megalin ligandor a megalin-binding fragment of such a ligand to such drugs may preventaccumulation of the active agent at the heart and associatedcardiotoxicity.

Suitable active agents include, but are not limited to: Antibiotics,such as: aminoglycosides, e.g., amikacin, apramycin, arbekacin,bambermycins, butirosin, dibekacin, dihydrostreptomycin, fortimicin,gentamicin, isepamicin, kanamycin, micronomcin, neomycin, netilmicin,paromycin, ribostamycin, sisomicin, spectinomycin, streptomycin,tobramycin, trospectomycin; amphenicols, e.g., azidamfenicol,chloramphenicol, florfenicol, and theimaphenicol; ansamycins, e.g.,rifamide, rifampin, rifamycin, rifapentine, rifaximin; beta.-lactams,e.g., carbacephems, carbapenems, cephalosporins, cehpamycins,monobactams, oxaphems, penicillins; lincosamides, e.g., clinamycin,lincomycin; macrolides, e.g., clarithromycin, dirthromycin,erythromycin, etc.; polypeptides, e.g., amphomycin, bacitracin,capreomycin, etc.; tetracyclines, e.g., apicycline, chlortetracycline,clomocycline, etc.; synthetic antibacterial agents, such as2,4-diaminopyrimidines, nitrofurans, quinolones and analogs thereof,sulfonamides, sulfones;

Suitable active agents include, but are not limited to: Antifungalagents, such as: polyenes, e.g., amphotericin B, candicidin,dermostatin, filipin, fungichromin, hachimycin, hamycin, lucensomycin,mepartricin, natamycin, nystatin, pecilocin, perimycin; syntheticantifungals, such as allylamines, e.g., butenafine, naftifine,terbinafine; imidazoles, e.g., bifonazole, butoconazole, chlordantoin,chlormidazole, etc., thiocarbamates, e.g., tolciclate, triazoles, e.g.,fluconazole, itraconazole, terconazole;

Suitable active agents include, but are not limited to: Antihelmintics,such as: arecoline, aspidin, aspidinol, dichlorophene, embelin, kosin,napthalene, niclosamide, pelletierine, quinacrine, alantolactone,amocarzine, amoscanate, ascaridole, bephenium, bitoscanate, carbontetrachloride, carvacrol, cyclobendazole, diethylcarbamazine, etc.;

Suitable active agents include, but are not limited to: Antimalarials,such as: acedapsone, amodiaquin, arteether, artemether, artemisinin,artesunate, atovaquone, bebeerine, berberine, chirata, chlorguanide,chloroquine, chlorprogaunil, cinchona, cinchonidine, cinchonine,cycloguanil, gentiopicrin, halofantrine, hydroxychloroquine, mefloquinehydrochloride, 3-methylarsacetin, pamaquine, plasmocid, primaquine,pyrimethamine, quinacrine, quinidine, quinine, quinocide, quinoline,dibasic sodium arsenate;

Suitable active agents include, but are not limited to: Antiprotozoanagents, such as: acranil, timidazole, ipronidazole, ethylstibamine,pentamidine, acetarsone, aminitrozole, anisomycin, nifuratel,timidazole, benzidazole, suramin, and the like.

Suitable drugs for use as active agents are also listed in: Goodman andGilman's, The Pharmacological Basis of Therapeutics (9th Ed) (Goodman etal. eds) (McGraw-Hill) (1996); and 1999 Physician's Desk Reference(1998).

Suitable active agents include, but are not limited to: antineoplasticagents, as disclosed in U.S. Pat. Nos. 5,880,161, 5,877,206, 5,786,344,5,760,041, 5,753,668, 5,698,529, 5,684,004, 5,665,715, 5,654,484,5,624,924, 5,618,813, 5,610,292, 5,597,831, 5,530,026, 5,525,633,5,525,606, 5,512,678, 5,508,277, 5,463,181, 5,409,893, 5,358,952,5,318,965, 5,223,503, 5,214,068, 5,196,424, 5,109,024, 5,106,996,5,101,072, 5,077,404, 5,071,848, 5,066,493, 5,019,390, 4,996,229,4,996,206, 4,970,318, 4,968,800, 4,962,114, 4,927,828, 4,892,887,4,889,859, 4,886,790, 4,882,334, 4,882,333, 4,871,746, 4,863,955,4,849,563, 4,845,216, 4,833,145, 4,824,955, 4,785,085, 4,684,747,4,618,685, 4,611,066, 4,550,187, 4,550,186, 4,544,501, 4,541,956,4,532,327, 4,490,540, 4,399,283, 4,391,982, 4,383,994, 4,294,763,4,283,394, 4,246,411, 4,214,089, 4,150,231, 4,147,798, 4,056,673,4,029,661, 4,012,448;

psychopharmacological/psychotropic agents, as disclosed in U.S. Pat.Nos. 5,192,799, 5,036,070, 4,778,800, 4,753,951, 4,590,180, 4,690,930,4,645,773, 4,427,694, 4,424,202, 4,440,781, 5,686,482, 5,478,828,5,461,062, 5,387,593, 5,387,586, 5,256,664, 5,192,799, 5,120,733,5,036,070, 4,977,167, 4,904,663, 4,788,188, 4,778,800, 4,753,951,4,690,930, 4,645,773, 4,631,285, 4,617,314, 4,613,600, 4,590,180,4,560,684, 4,548,938, 4,529,727, 4,459,306, 4,443,451, 4,440,781,4,427,694, 4,424,202, 4,397,853, 4,358,451, 4,324,787, 4,314,081,4,313,896, 4,294,828, 4,277,476, 4,267,328, 4,264,499, 4,231,930,4,194,009, 4,188,388, 4,148,796, 4,128,717, 4,062,858, 4,031,226,4,020,072, 4,018,895, 4,018,779, 4,013,672, 3,994,898, 3,968,125,3,939,152, 3,928,356, 3,880,834, 3,668,210;

cardiovascular agents, as disclosed in U.S. Pat. Nos. 4,966,967,5,661,129, 5,552,411, 5,332,737, 5,389,675, 5,198,449, 5,079,247,4,966,967, 4,874,760, 4,954,526, 5,051,423, 4,888,335, 4,853,391,4,906,634, 4,775,757, 4,727,072, 4,542,160, 4,522,949, 4,524,151,4,525,479, 4,474,804, 4,520,026, 4,520,026, 5,869,478, 5,859,239,5,837,702, 5,807,889, 5,731,322, 5,726,171, 5,723,457, 5,705,523,5,696,111, 5,691,332, 5,679,672, 5,661,129, 5,654,294, 5,646,276,5,637,586, 5,631,251, 5,612,370, 5,612,323, 5,574,037, 5,563,170,5,552,411, 5,552,397, 5,547,966, 5,482,925, 5,457,118, 5,414,017,5,414,013, 5,401,758, 5,393,771, 5,362,902, 5,332,737, 5,310,731,5,260,444, 5,223,516, 5,217,958, 5,208,245, 5,202,330, 5,198,449,5,189,036, 5,185,362, 5,140,031, 5,128,349, 5,116,861, 5,079,247,5,070,099, 5,061,813, 5,055,466, 5,051,423, 5,036,065, 5,026,712,5,011,931, 5,006,542, 4,981,843, 4,977,144, 4,971,984, 4,966,967,4,959,383, 4,954,526, 4,952,692, 4,939,137, 4,906,634, 4,889,866,4,888,335, 4,883,872, 4,883,811, 4,847,379, 4,835,157, 4,824,831,4,780,538, 4,775,757, 4,774,239, 4,771,047, 4,769,371, 4,767,756,4,762,837, 4,753,946, 4,752,616, 4,749,715, 4,738,978, 4,735,962,4,734,426, 4,734,425, 4,734,424, 4,730,052, 4,727,072, 4,721,796,4,707,550, 4,704,382, 4,703,120, 4,681,970, 4,681,882, 4,670,560,4,670,453, 4,668,787, 4,663,337, 4,663,336, 4,661,506, 4,656,267,4,656,185, 4,654,357, 4,654,356, 4,654,355, 4,654,335, 4,652,578,4,652,576, 4,650,874, 4,650,797, 4,649,139, 4,647,585, 4,647,573,4,647,565, 4,647,561, 4,645,836, 4,639,461, 4,638,012, 4,638,011,4,632,931, 4,631,283, 4,628,095, 4,626,548, 4,614,825, 4,611,007,4,611,006, 4,611,005, 4,609,671, 4,608,386, 4,607,049, 4,607,048,4,595,692, 4,593,042, 4,593,029, 4,591,603, 4,588,743, 4,588,742,4,588,741, 4,582,854, 4,575,512, 4,568,762, 4,560,698, 4,556,739,4,556,675, 4,555,571, 4,555,570, 4,555,523, 4,550,120, 4,542,160,4,542,157, 4,542,156, 4,542,155, 4,542,151, 4,537,981, 4,537,904,4,536,514, 4,536,513, 4,533,673, 4,526,901, 4,526,900, 4,525,479,4,524,151, 4,522,949, 4,521,539, 4,520,026, 4,517,188, 4,482,562,4,474,804, 4,474,803, 4,472,411, 4,466,979, 4,463,015, 4,456,617,4,456,616, 4,456,615, 4,418,076, 4,416,896, 4,252,815, 4,220,594,4,190,587, 4,177,280, 4,164,586, 4,151,297, 4,145,443, 4,143,054,4,123,550, 4,083,968, 4,076,834, 4,064,259, 4,064,258, 4,064,257,4,058,620, 4,001,421, 3,993,639, 3,991,057, 3,982,010, 3,980,652,3,968,117, 3,959,296, 3,951,950, 3,933,834, 3,925,369, 3,923,818,3,898,210, 3,897,442, 3,897,441, 3,886,157, 3,883,540, 3,873,715,3,867,383, 3,873,715, 3,867,383, 3,691,216, 3,624,126;

antimicrobial agents as disclosed in U.S. Pat. Nos. 5,902,594,5,874,476, 5,874,436, 5,859,027, 5,856,320, 5,854,242, 5,811,091,5,786,350, 5,783,177, 5,773,469, 5,762,919, 5,753,715, 5,741,526,5,709,870, 5,707,990, 5,696,117, 5,684,042, 5,683,709, 5,656,591,5,643,971, 5,643,950, 5,610,196, 5,608,056, 5,604,262, 5,595,742,5,576,341, 5,554,373, 5,541,233, 5,534,546, 5,534,508, 5,514,715,5,508,417, 5,464,832, 5,428,073, 5,428,016, 5,424,396, 5,399,553,5,391,544, 5,385,902, 5,359,066, 5,356,803, 5,354,862, 5,346,913,5,302,592, 5,288,693, 5,266,567, 5,254,685, 5,252,745, 5,209,930,5,196,441, 5,190,961, 5,175,160, 5,157,051, 5,096,700, 5,093,342,5,089,251, 5,073,570, 5,061,702, 5,037,809, 5,036,077, 5,010,109,4,970,226, 4,916,156, 4,888,434, 4,870,093, 4,855,318, 4,784,991,4,746,504, 4,686,221, 4,599,228, 4,552,882, 4,492,700, 4,489,098,4,489,085, 4,487,776, 4,479,953, 4,477,448, 4,474,807, 4,470,994,4,370,484, 4,337,199, 4,311,709, 4,308,283, 4,304,910, 4,260,634,4,233,311, 4,215,131, 4,166,122, 4,141,981, 4,130,664, 4,089,977,4,089,900, 4,069,341, 4,055,655, 4,049,665, 4,044,139, 4,002,775,3,991,201, 3,966,968, 3,954,868, 3,936,393, 3,917,476, 3,915,889,3,867,548, 3,865,748, 3,867,548, 3,865,748, 3,783,160, 3,764,676,3,764,677;

anti-inflammatory agents as disclosed in U.S. Pat. Nos. 5,872,109,5,837,735, 5,827,837, 5,821,250, 5,814,648, 5,780,026, 5,776,946,5,760,002, 5,750,543, 5,741,798, 5,739,279, 5,733,939, 5,723,481,5,716,967, 5,688,949, 5,686,488, 5,686,471, 5,686,434, 5,684,204,5,684,041, 5,684,031, 5,684,002, 5,677,318, 5,674,891, 5,672,620,5,665,752, 5,656,661, 5,635,516, 5,631,283, 5,622,948, 5,618,835,5,607,959, 5,593,980, 5,593,960, 5,580,888, 5,552,424, 5,552,422,5,516,764, 5,510,361, 5,508,026, 5,500,417, 5,498,405, 5,494,927,5,476,876, 5,472,973, 5,470,885, 5,470,842, 5,464,856, 5,464,849,5,462,952, 5,459,151, 5,451,686, 5,444,043, 5,436,265, 5,432,181,RE034918, 5,393,756, 5,380,738, 5,376,670, 5,360,811, 5,354,768,5,348,957, 5,347,029, 5,340,815, 5,338,753, 5,324,648, 5,319,099,5,318,971, 5,312,821, 5,302,597, 5,298,633, 5,298,522, 5,298,498,5,290,800, 5,290,788, 5,284,949, 5,280,045, 5,270,319, 5,266,562,5,256,680, 5,250,700, 5,250,552, 5,248,682, 5,244,917, 5,240,929,5,234,939, 5,234,937, 5,232,939, 5,225,571, 5,225,418, 5,220,025,5,212,189, 5,212,172, 5,208,250, 5,204,365, 5,202,350, 5,196,431,5,191,084, 5,187,175, 5,185,326, 5,183,906, 5,177,079, 5,171,864,5,169,963, 5,155,122, 5,143,929, 5,143,928, 5,143,927, 5,124,455,5,124,347, 5,114,958, 5,112,846, 5,104,656, 5,098,613, 5,095,037,5,095,019, 5,086,064, 5,081,261, 5,081,147, 5,081,126, 5,075,330,5,066,668, 5,059,602, 5,043,457, 5,037,835, 5,037,811, 5,036,088,5,013,850, 5,013,751, 5,013,736, 5,006,542, 4,992,448, 4,992,447,4,988,733, 4,988,728, 4,981,865, 4,962,119, 4,959,378, 4,954,519,4,945,099, 4,942,236, 4,931,457, 4,927,835, 4,912,248, 4,910,192,4,904,786, 4,904,685, 4,904,674, 4,904,671, 4,897,397, 4,895,953,4,891,370, 4,870,210, 4,859,686, 4,857,644, 4,853,392, 4,851,412,4,847,303, 4,847,290, 4,845,242, 4,835,166, 4,826,990, 4,803,216,4,801,598, 4,791,129, 4,788,205, 4,778,818, 4,775,679, 4,772,703,4,767,776, 4,764,525, 4,760,051, 4,748,153, 4,725,616, 4,721,712,4,713,393, 4,708,966, 4,695,571, 4,686,235, 4,686,224, 4,680,298,4,678,802, 4,652,564, 4,644,005, 4,632,923, 4,629,793, 4,614,741,4,599,360, 4,596,828, 4,595,694, 4,595,686, 4,594,357, 4,585,755,4,579,866, 4,578,390, 4,569,942, 4,567,201, 4,563,476, 4,559,348,4,558,067, 4,556,672, 4,556,669, 4,539,326, 4,537,903, 4,536,503,4,518,608, 4,514,415, 4,512,990, 4,501,755, 4,495,197, 4,493,839,4,465,687, 4,440,779, 4,440,763, 4,435,420, 4,412,995, 4,400,534,4,355,034, 4,335,141, 4,322,420, 4,275,064, 4,244,963, 4,235,908,4,234,593, 4,226,887, 4,201,778, 4,181,720, 4,173,650, 4,173,634,4,145,444, 4,128,664, 4,125,612, 4,124,726, 4,124,707, 4,117,135,4,027,031, 4,024,284, 4,021,553, 4,021,550, 4,018,923, 4,012,527,4,011,326, 3,998,970, 3,998,954, 3,993,763, 3,991,212, 3,984,405,3,978,227, 3,978,219, 3,978,202, 3,975,543, 3,968,224, 3,959,368,3,949,082, 3,949,081, 3,947,475, 3,936,450, 3,934,018, 3,930,005,3,857,955, 3,856,962, 3,821,377, 3,821,401, 3,789,121, 3,789,123,3,726,978, 3,694,471, 3,691,214, 3,678,169, 3,624,216;

immunosuppressive agents, as disclosed in U.S. Pat. Nos. 4,450,159,4,450,159, 5,905,085, 5,883,119, 5,880,280, 5,877,184, 5,874,594,5,843,452, 5,817,672, 5,817,661, 5,817,660, 5,801,193, 5,776,974,5,763,478, 5,739,169, 5,723,466, 5,719,176, 5,696,156, 5,695,753,5,693,648, 5,693,645, 5,691,346, 5,686,469, 5,686,424, 5,679,705,5,679,640, 5,670,504, 5,665,774, 5,665,772, 5,648,376, 5,639,455,5,633,277, 5,624,930, 5,622,970, 5,605,903, 5,604,229, 5,574,041,5,565,560, 5,550,233, 5,545,734, 5,540,931, 5,532,248, 5,527,820,5,516,797, 5,514,688, 5,512,687, 5,506,233, 5,506,228, 5,494,895,5,484,788, 5,470,857, 5,464,615, 5,432,183, 5,431,896, 5,385,918,5,349,061, 5,344,925, 5,330,993, 5,308,837, 5,290,783, 5,290,772,5,284,877, 5,284,840, 5,273,979, 5,262,533, 5,260,300, 5,252,732,5,250,678, 5,247,076, 5,244,896, 5,238,689, 5,219,884, 5,208,241,5,208,228, 5,202,332, 5,192,773, 5,189,042, 5,169,851, 5,162,334,5,151,413, 5,149,701, 5,147,877, 5,143,918, 5,138,051, 5,093,338,5,091,389, 5,068,323, 5,068,247, 5,064,835, 5,061,728, 5,055,290,4,981,792, 4,810,692, 4,410,696, 4,346,096, 4,342,769, 4,317,825,4,256,766, 4,180,588, 4,000,275, 3,759,921;

immunomodulatory agents, as disclosed in U.S. Pat. Nos. 4,446,128,4,524,147, 4,720,484, 4,722,899, 4,748,018, 4,877,619, 4,998,931,5,049,387, 5,118,509, 5,152,980, 5,256,416, 5,468,729, 5,583,139,5,604,234, 5,612,060, 5,612,350, 5,658,564, 5,672,605, 5,681,571,5,708,002, 5,723,718, 5,736,143, 5,744,495, 5,753,687, 5,770,201,5,869,057, 5,891,653, 5,939,455, 5,948,407, 6,006,752, 6,024,957,6,030,624, 6,037,372, 6,037,373, 6,043,247, 6,060,049, 6,087,096,6,096,315, 6,099,838, 6,103,235, 6,124,495, 6,153,203, 6,169,087,6,255,278, 6,262,044, 6,290,950, 6,306,651, 6,322,796, 6,329,153,6,344,476, 6,352,698, 6,365,163, 6,379,668, 6,391,303, 6,395,767,6,403,555, 6,410,556, 6,412,492, 6,468,537, 6,489,330, 6,521,232,6,525,035, 6,525,242, 6,558,663, 6,572,860;

analgesic agents, as disclosed in U.S. Pat. Nos. 5,292,736, 5,688,825,5,554,789, 5,455,230, 5,292,736, 5,298,522, 5,216,165, 5,438,064,5,204,365, 5,017,578, 4,906,655, 4,906,655, 4,994,450, 4,749,792,4,980,365, 4,794,110, 4,670,541, 4,737,493, 4,622,326, 4,536,512,4,719,231, 4,533,671, 4,552,866, 4,539,312, 4,569,942, 4,681,879,4,511,724, 4,556,672, 4,721,712, 4,474,806, 4,595,686, 4,440,779,4,434,175, 4,608,374, 4,395,402, 4,400,534, 4,374,139, 4,361,583,4,252,816, 4,251,530, 5,874,459, 5,688,825, 5,554,789, 5,455,230,5,438,064, 5,298,522, 5,216,165, 5,204,365, 5,030,639, 5,017,578,5,008,264, 4,994,450, 4,980,365, 4,906,655, 4,847,290, 4,844,907,4,794,110, 4,791,129, 4,774,256, 4,749,792, 4,737,493, 4,721,712,4,719,231, 4,681,879, 4,670,541, 4,667,039, 4,658,037, 4,634,708,4,623,648, 4,622,326, 4,608,374, 4,595,686, 4,594,188, 4,569,942,4,556,672, 4,552,866, 4,539,312, 4,536,512, 4,533,671, 4,511,724,4,440,779, 4,434,175, 4,400,534, 4,395,402, 4,391,827, 4,374,139,4,361,583, 4,322,420, 4,306,097, 4,252,816, 4,251,530, 4,244,955,4,232,018, 4,209,520, 4,164,514, 4,147,872, 4,133,819, 4,124,713,4,117,012, 4,064,272, 4,022,836, 3,966,944;

cholinergic agents, as disclosed in U.S. Pat. Nos. 5,219,872, 5,219,873,5,073,560, 5,073,560, 5,346,911, 5,424,301, 5,073,560, 5,219,872,4,900,748, 4,786,648, 4,798,841, 4,782,071, 4,710,508, 5,482,938,5,464,842, 5,378,723, 5,346,911, 5,318,978, 5,219,873, 5,219,872,5,084,281, 5,073,560, 5,002,955, 4,988,710, 4,900,748, 4,798,841,4,786,648, 4,782,071, 4,745,123, 4,710,508;

adrenergic agents, as disclosed in U.S. Pat. Nos. 5,091,528, 5,091,528,4,835,157, 5,708,015, 5,594,027, 5,580,892, 5,576,332, 5,510,376,5,482,961, 5,334,601, 5,202,347, 5,135,926, 5,116,867, 5,091,528,5,017,618, 4,835,157, 4,829,086, 4,579,867, 4,568,679, 4,469,690,4,395,559, 4,381,309, 4,363,808, 4,343,800, 4,329,289, 4,314,943,4,311,708, 4,304,721, 4,296,117, 4,285,873, 4,281,189, 4,278,608,4,247,710, 4,145,550, 4,145,425, 4,139,535, 4,082,843, 4,011,321,4,001,421, 3,982,010, 3,940,407, 3,852,468, 3,832,470;

antihistamine agents, as disclosed in U.S. Pat. Nos. 5,874,479,5,863,938, 5,856,364, 5,770,612, 5,702,688, 5,674,912, 5,663,208,5,658,957, 5,652,274, 5,648,380, 5,646,190, 5,641,814, 5,633,285,5,614,561, 5,602,183, 4,923,892, 4,782,058, 4,393,210, 4,180,583,3,965,257, 3,946,022, 3,931,197;

steroidal agents, as disclosed in U.S. Pat. Nos. 5,863,538, 5,855,907,5,855,866, 5,780,592, 5,776,427, 5,651,987, 5,346,887, 5,256,408,5,252,319, 5,209,926, 4,996,335, 4,927,807, 4,910,192, 4,710,495,4,049,805, 4,004,005, 3,670,079, 3,608,076, 5,892,028, 5,888,995,5,883,087, 5,880,115, 5,869,475, 5,866,558, 5,861,390, 5,861,388,5,854,235, 5,837,698, 5,834,452, 5,830,886, 5,792,758, 5,792,757,5,763,361, 5,744,462, 5,741,787, 5,741,786, 5,733,899, 5,731,345,5,723,638, 5,721,226, 5,712,264, 5,712,263, 5,710,144, 5,707,984,5,705,494, 5,700,793, 5,698,720, 5,698,545, 5,696,106, 5,677,293,5,674,861, 5,661,141, 5,656,621, 5,646,136, 5,637,691, 5,616,574,5,614,514, 5,604,215, 5,604,213, 5,599,807, 5,585,482, 5,565,588,5,563,259, 5,563,131, 5,561,124, 5,556,845, 5,547,949, 5,536,714,5,527,806, 5,506,354, 5,506,221, 5,494,907, 5,491,136, 5,478,956,5,426,179, 5,422,262, 5,391,776, 5,382,661, 5,380,841, 5,380,840,5,380,839, 5,373,095, 5,371,078, 5,352,809, 5,344,827, 5,344,826,5,338,837, 5,336,686, 5,292,906, 5,292,878, 5,281,587, 5,272,140,5,244,886, 5,236,912, 5,232,915, 5,219,879, 5,218,109, 5,215,972,5,212,166, 5,206,415, 5,194,602, 5,166,201, 5,166,055, 5,126,488,5,116,829, 5,108,996, 5,099,037, 5,096,892, 5,093,502, 5,086,047,5,084,450, 5,082,835, 5,081,114, 5,053,404, 5,041,433, 5,041,432,5,034,548, 5,032,586, 5,026,882, 4,996,335, 4,975,537, 4,970,205,4,954,446, 4,950,428, 4,946,834, 4,937,237, 4,921,846, 4,920,099,4,910,226, 4,900,725, 4,892,867, 4,888,336, 4,885,280, 4,882,322,4,882,319, 4,882,315, 4,874,855, 4,868,167, 4,865,767, 4,861,875,4,861,765, 4,861,763, 4,847,014, 4,774,236, 4,753,932, 4,711,856,4,710,495, 4,701,450, 4,701,449, 4,689,410, 4,680,290, 4,670,551,4,664,850, 4,659,516, 4,647,410, 4,634,695, 4,634,693, 4,588,530,4,567,000, 4,560,557, 4,558,041, 4,552,871, 4,552,868, 4,541,956,4,519,946, 4,515,787, 4,512,986, 4,502,989, 4,495,102; the disclosuresof all the above of which are herein incorporated by reference.

The drug moiety of the conjugate may be the whole drug or a bindingfragment or portion thereof that retains its affinity and specificityfor the target of interest while having a linkage site for covalentbonding to the vector protein ligand or linker. The conjugates of suchdrugs may be used for the same disorders, diseases, and indications asthe drugs themselves.

C. Preferred Cancer Chemotherapeutic Active Agents

Preferred cancer chemotherapeutic agents for use in the megalin ligandbased conjugates of the invention include all drugs which may be usefulfor treating brain tumors or other neoplasia in or around the brain,either in the free form, or, if not so useful for such tumors in thefree form, then useful when linked to the megalin ligand or megalinbinding fragment thereof. Such chemotherapeutic agents are preferablycytotoxic chemotherapeutic agents including but not limited toadriamycin (also known as doxorubicin), cisplatin, paclitaxel, analogsthereof, and other chemotherapeutic agents demonstrate activity againsttumours ex vivo and in vivo. Such chemotherapeutic agents also includealkylating agents, antimetabolites, natural products (such as vincaalkaloids, epidophyllotoxins, antibiotics, enzymes and biologicalresponse modifiers), topoisomerase inhibitors, microtubule inhibitors,spindle poisons, hormones and antagonists, and miscellaneous agents suchas platinum coordination complexes, anthracendiones, substituted ureas,etc. hose of skill in the art will know of other chemotherapeuticagents.

Preferred chemotherapeutic agents are those, which in the free form,demonstrate unacceptable systemic toxicity at desired doses. The generalsystemic toxicity associated with therapeutic levels of such agents isreduced by their linkage to a megalin ligand or a megalin bindingfragment of a megalin ligand. Particularly preferred are cardiotoxiccompounds that are useful therapeutics but are dose limited bycardiotoxicity. A classic example is adriamycin (also known asdoxorubicin) and its analogs, such as daunorubicin. Linking a megalinligand or a megalin-binding fragment thereof to such drugs decreasesaccumulation and associated cardiotoxicity at the heart.

VII. METHODS FOR MAKING CONJUGATES

The present invention generally provides methods and compositionscomprising megalin ligands or megalin-binding fragments thereof linkedto an active agent.

In general, ligand-active agent conjugates can be prepared usingtechniques known in the art. There are numerous approaches for theconjugation or chemical crosslinking of compounds to proteins and oneskilled in the art can determine which method is appropriate for theactive agent to be conjugated. The method employed must be capable ofjoining the active agent to the megalin ligand or megalin-bindingfragment thereof without interfering with the ability of the megalinligand/fragment to bind to megalin, preferably without altering thedesired activity of the compound once delivered. Preferred methods ofconjugating the ligand to various compounds are set out in the examplesection, below. Particularly preferred for linking complex molecules toa megalin ligand, such as RAP, is the SATA/sulfo-SMCC cross-linkingreaction (Pierce, Rockford, Ill.). For linking metals to megalin ligand,preferred reactions include, but are not limited to, binding to tyrosineresidues through Chloramine T methods, or use of Iodo beads (Pierce) foriodination reactions.

Methods for conjugating the megalin ligand with the representativelabels set forth above may be readily accomplished by one of ordinaryskill in the art (see, Trichothecene Antibody Conjugate, U.S. Pat. No.4,744,981; Antibody Conjugate, U.S. Pat. No. 5,106,951; FluorogenicMaterials and Labeling Techniques, U.S. Pat. No. 4,018,884; MetalRadionuclide Labeled Proteins for Diagnosis and Therapy, U.S. Pat. No.4,897,255; and Metal Radionuclide Chelating Compounds for ImprovedChelation Kinetics, U.S. Pat. No. 4,988,496; see also Inman, Methods InEnzymology, Vol. 34, Affinity Techniques, Enzyme Purification: Part B,Jakoby and Wichek (eds.), Academic Press, New York, p. 30, 1974; seealso Wilchek and Bayer, “The Avidin-Biotin Complex in BioanalyticalApplications,” Anal. Biochem. 171:1-32, 1988; all incorporated herein byreference in their entirety for all purposes).

If the active agent is a protein or a peptide, there are manycrosslinkers available in order to conjugate the active agent with themegalin ligand or megalin binding fragment thereof. (See for example,Chemistry of Protein Conjugation and Crosslinking. 1991, Shans Wong, CRCPress, Ann Arbor). The crosslinker is generally chosen based on thereactive functional groups available or inserted on the therapeuticcompound. In addition, if there are no reactive groups aphotoactivatible crosslinker can be used. In certain instances, it maybe desirable to include a spacer between the megalin ligand and theactive agent. In one example, megalin ligand and protein therapeuticcompounds can be conjugated by the introduction of a sulfhydryl group onthe megalin ligand and the introduction of a cross-linker containing areactive thiol group on to the protein compound through carboxyl groups(see, Wawizynczak and Thorpe, in Immunoconjugates: Antibody Conjugatesin Radioimaging and Therapy of Cancer, C. W. Vogel (Ed.) OxfordUniversity Press, 1987, pp. 28-55.; and Blair and Ghose, J. Immunol.Methods 59:129, 1983).

Ligand-chemotherapeutic agents can comprise one or more compoundmoieties linked to the megalin ligand or megalin-binding fragmentthereof. For example, conjugation reactions may conjugate from 1 to 10or more molecules of adriamycin to a single megalin ligand molecule.Several atoms of gold or iodine can be conjugated to a single megalinligand or megalin-binding fragment thereof. These formulations can beemployed as mixtures, or they may be purified into specific megalinligand-active compound stoichiometric formulations. Those skilled in theart are able to determine which format and which stoichiometric ratio ispreferred. Further, mixtures of active compounds may be linked to themegalin ligand or megalin-binding fragment thereof, such as the RAPadriamycin-cisplatinum composition set out in the examples. Thesemegalin ligand-active agent conjugates may consist of a range ofstoichiometric ratios of ligand to an active agent (e.g., RAP:activeagent ratios of 1:1 to 1:4; 1:5 to 1:10; or 1:10 to 1:20). Optionally, aplurality of different active agents (e.g. 2, 3, or 4 such agents) maybe each conjugated to the megalin ligand or megalin-binding fragmentthereof in its own stoichiometric ratio such that megalin ligand ormegalin-binding fragment thereof to the total ratio of such additionalactive agents is not fewer than 1 megalin ligand or megalin-bindingfragment thereof per 20 active agents. These, too, may be separated intopurified mixtures or they may be employed in aggregate.

The linker is preferably an organic moiety constructed to contain analkyl, aryl and/or amino acid backbone and which will contain an amide,ether, ester, hydrazone, disulphide linkage or any combination thereof.Linkages containing amino acid, ether and amide bound components will bestable under conditions of physiological pH, normally 7.4 in serum and4-5 on uptake into cells (endosomes). Preferred linkages are linkagescontaining esters or hydrazones that are stable at serum pH buthydrolyse to release the drug when exposed to intracellular pH.Disulphide linkages are preferred because they are sensitive toreductive cleavage; amino acid linkers can be designed to be sensitiveto cleavage by specific enzymes in the desired target organ. Exemplarylinkers are set out in Blattler et al. Biochem. 24:1517-1524, 1985; Kinget al. Biochem. 25:5774-5779, 1986; Srinivasachar and Nevill, Biochem.28:2501-2509, 1989.

Drug-Linker intermediates are similar to what has been described abovebut with either an active ester to react with free amine groups on themegalin ligand or megalin-binding fragment thereof or a maleimide toreact with the free thiols that have been created on the megalin ligandor megalin-binding fragment thereof through other groups where personsskilled in the art can attach them to megalin ligand or megalin-bindingfragment thereof.

Methods of crosslinking proteins and peptides are well known to those ofskill in the art. Several hundred crosslinkers are available forconjugating a compound of interest with a polypeptide such as a megalinligand or megalin-binding fragment thereof or with a substance whichbinds such as a ligand (see, e.g., Chemistry of Protein Conjugation andCrosslinking, Shans Wong, CRC Press, Ann Arbor (1991) and U.S. Pat. No.5,981,194 and PCT Patent Publication Nos. WO 02/13843 and WO 01/59459which are incorporated herein by reference in their entirety). Manyreagents and cross-linkers can be used to prepare conjugates of anactive agent and a megalin ligand such as a RAP molecule, for instance,Hermanson et al. Bioconjugate Techniques, Academic Press, (1996). Thecrosslinker is generally chosen based on the reactive functional groupsavailable or inserted on the therapeutic agent. In addition, if thereare no reactive groups, a photoactivatible crosslinker can be used. Incertain instances, it may be desirable to include a spacer betweenmegalin ligand and the agent. In one embodiment, megalin ligand and theprotein therapeutic agents may be conjugated by the introduction of asulfhydryl group on megalin ligand and by the introduction of acrosslinker containing a reactive thiol group on to the protein compoundthrough carboxyl groups (Wawizynczak and Thorpe in Immunoconjugates:Antibody Conjugates in Radioimaging and Therapy of Cancer, Vogel (Ed.)Oxford University Press, pp. 28-55 (1987); and Blair and Ghose (1983) J.Immunol. Methods 59:129). In some embodiments, the linker is vulnerableto hydrolysis at the acidic pH of the lysosome so as to free the agentfrom the and/or linker.

When a linker is used, the linker is preferably an organic moietyconstructed to contain an alkyl, aryl and/or amino acid backbone, andcontaining an amide, ether, ester, hydrazone, disulphide linkage or anycombination thereof. Linkages containing amino acid, ether and amidebound components are stable under conditions of physiological pH,normally 7.4 in serum. Preferred linkages are those containing esters orhydrazones that are stable at serum pH, but that hydrolyze to releasethe drug when exposed to lysosomal pH. Disulphide linkages are preferredbecause they are sensitive to reductive cleavage. In addition, aminoacid linkers may be designed to be sensitive to cleavage by specificenzymes in the desired target organ or more preferably, the lysosomeitself. Exemplary linkers are described in Blattler et al. (1985)Biochem. 24:1517-1524; King et al. (1986) Biochem. 25:5774-5779;Srinivasachar and Nevill (1989) Biochem. 28:2501-2509.

In some embodiments, the linker is a polyethylene glycol orpolypropylene glycol. In other embodiments, the linker is from 4 to 20atoms long. In other embodiments, the linker is from 1 to 30 atoms longwith carbon chain atoms that may be substituted by heteroatomsindependently selected from the group consisting of O, N. or S. In someembodiments, from 1 to 4 or up to one-third of the C atoms aresubstituted with a heteroatom independently selected from O, N, S. Inother embodiments, the linker contains a moiety subject to hydrolysisupon delivery to the lysosomal environment (e.g., susceptible tohydrolysis at the lysosomal pH or upon contact to a lysosomal enzyme).In some embodiments, the linker group is preferably hydrophilic toenhance the solubility of the conjugate in body fluids. In someembodiments, the linker contains or is attached to the megalin ligandmolecule or the protein agent by a functional group subject to attack byother lysosomal enzymes (e.g., enzymes not deficient in the targetlysosome or a lysosomal enzyme not conjugated to the megalin ligandcarrier). In some embodiments, the megalin ligand and agent are joinedby a linker comprising amino acids or peptides, lipids, or sugarresidues. In some embodiments, the megalin ligand and agent are joinedat groups introduced synthetically or by post-translationalmodifications.

In some embodiments, agent-linker intermediates are similar to what hasbeen described previously, but comprise, for example, either an activeester that can react with free amine groups on megalin ligand or amaleimide that can react with the free thiols created on megalin ligandvia a SATA reaction or through other groups to which the active agentmay be attached.

A. Methods for Conjugating a Megalin Ligand Polypeptide to a Protein orEnzyme.

One of ordinary skill in the art would know how to conjugate an activeagent to a protein or peptide. Methods of conjugating active agents andlabels to proteins are well known in the art. See, for instance, U.S.Pat. No. 5,981,194. Many reagents and cross linkers can be used toprepare bioconjugates of an active agent and a biopolymer. See, forinstance, Hermanson et al. Bioconjugate Techniques, Academic Press,(1996).

In some embodiments of the present invention, the megalin ligand and theactive agent are both polypeptides and the megalin ligand-active agentconjugate is a fusion protein. Fusion proteins may be prepared usingstandard techniques known in the art. Typically, a DNA molecule encodingthe megalin ligand or a portion thereof is linked to a DNA moleculeencoding the protein compound. The chimeric DNA construct, along withsuitable regulatory elements can be cloned into an expression vector andexpressed in a suitable host. The resultant fusion proteins containmegalin ligand or a portion thereof used to the selected proteincompound. Megalin ligand-LSD enzyme proteins are particularlycontemplated, and exemplary such conjugates include the RAP-human alphaglucosidase and RAP-iduronidase conjugates/fusion proteins described inExample VII and FIGS. 3 and 4. These fusion proteins were prepared usingstandard techniques known in the art.

The chimeric protein of the present invention can be produced using hostcells expressing a single nucleic acid encoding the entire chimericprotein or more than one nucleic acid sequence, each encoding a domainof the chimeric protein and, optionally, an amino acid or amino acidswhich will serve to link the domains. The chimeric proteins can also beproduced by chemical synthesis.

Host Cells

Host cells used to produce chimeric proteins are bacterial, yeast,insect, non-mammalian vertebrate, or mammalian cells; the mammaliancells include, but are not limited to, hamster, monkey, chimpanzee, dog,cat, bovine, porcine, mouse, rat, rabbit, sheep and human cells. Thehost cells can be immortalized cells (a cell line) or non-immortalized(primary or secondary) cells and can be any of a wide variety of celltypes, such as, but not limited to, fibroblasts, keratinocytes,epithelial cells (e.g., mammary epithelial cells, intestinal epithelialcells), ovary cells (e.g., Chinese hamster ovary or CHO cells),endothelial cells, glial cells, neural cells, formed elements of theblood (e.g., lymphocytes, bone marrow cells), muscle cells, hepatocytesand precursors of these somatic cell types. Host cells can includemutants of CHO cells that do not express LRP such as CHO13-5-1(FitzGerald et al., J. Biol. Chem., 129(6):1533-41, 1995).

Cells that contain and express DNA or RNA encoding the chimeric proteinare referred to herein as genetically modified cells. Mammalian cellsthat contain and express DNA or RNA encoding the chimeric protein arereferred to as genetically modified mammalian cells. Introduction of theDNA or RNA into cells is by a known transfection method, such aselectroporation, microinjection, microprojectile bombardment, calciumphosphate precipitation, modified calcium phosphate precipitation,cationic lipid treatment, photoporation, fusion methodologies, receptormediated transfer, or polybrene precipitation. Alternatively, the DNA orRNA can be introduced by infection with a viral vector. Methods ofproducing cells, including mammalian cells, which express DNA or RNAencoding a chimeric protein are described in co-pending patentapplications U.S. Ser. No. 08/334,797, entitled “In Vivo ProteinProduction and Delivery System for Gene Therapy”, by Richard F Selden,Douglas A. Treco and Michael W. Heartlein (filed Nov. 4, 1994); U.S.Ser. No. 08/334,455, entitled “In Vivo Production and Delivery ofErythropoietin or Insulinotropin for Gene Therapy”, by Richard F Selden,Douglas A. Treco and Michael W. Heartlein (filed Nov. 4, 1994) and U.S.Ser. No. 08/231,439, entitled “Targeted Introduction of DNA Into Primaryor Secondary Cells and Their Use for Gene Therapy”, by Douglas A. Treco,Michael W. Heartlein and Richard F Selden (filed Apr. 20, 1994). Theteachings of each of these applications are expressly incorporatedherein by reference in their entirety.

Nucleic Acid Constructs

A nucleic acid construct used to express the chimeric protein can be onewhich is expressed extrachromosomally (episomally) in the transfectedmammalian cell or one which integrates, either randomly or at apre-selected targeted site through homologous recombination, into therecipient cell's genome. A construct which is expressedextrachromosomally comprises, in addition to chimeric protein-encodingsequences, sequences sufficient for expression of the protein in thecells and, optionally, for replication of the construct. It typicallyincludes a promoter, chimeric protein-encoding DNA and a polyadenylationsite. The DNA encoding the chimeric protein is positioned in theconstruct in such a manner that its expression is under the control ofthe promoter. Optionally, the construct may contain additionalcomponents such as one or more of the following: a splice site, anenhancer sequence, a selectable marker gene under the control of anappropriate promoter, and an amplifiable marker gene under the controlof an appropriate promoter.

In those embodiments in which the DNA construct integrates into thecell's genome, it need include only the chimeric protein-encodingnucleic acid sequences. Optionally, it can include a promoter and anenhancer sequence, a polyadenylation site or sites, a splice site orsites, nucleic acid sequences which encode a selectable marker ormarkers, nucleic acid sequences which encode an amplifiable markerand/or DNA homologous to genomic DNA in the recipient cell to targetintegration of the DNA to a selected site in the genome (targeting DNAor DNA sequences).

Cell Culture Methods

Mammalian cells containing the chimeric protein-encoding DNA or RNA arecultured under conditions appropriate for growth of the cells andexpression of the DNA or RNA. Those cells which express the chimericprotein can be identified, using known methods and methods describedherein, and the chimeric protein isolated and purified, using knownmethods and methods also described herein; either with or withoutamplification of chimeric protein production. Identification can becarried out, for example, through screening genetically modifiedmammalian cells displaying a phenotype indicative of the presence of DNAor RNA encoding the chimeric protein, such as PCR screening, screeningby Southern blot analysis, or screening for the expression of thechimeric protein. Selection of cells having incorporated chimericprotein-encoding DNA may be accomplished by including a selectablemarker in the DNA construct and culturing transfected or infected cellscontaining a selectable marker gene under conditions appropriate forsurvival of only those cells that express the selectable marker gene.Further amplification of the introduced DNA construct can be affected byculturing genetically modified mammalian cells under conditionsappropriate for amplification (e.g., culturing genetically modifiedmammalian cells containing an amplifiable marker gene in the presence ofa concentration of a drug at which only cells containing multiple copiesof the amplifiable marker gene can survive).

Genetically modified mammalian cells expressing the chimeric protein canbe identified, as described herein, by detection of the expressionproduct. For example, mammalian cells expressing chimeric protein inwhich the carrier is a megalin ligand can be identified by a sandwichenzyme immunoassay. The antibodies can be directed toward themegalin-binding portion or the active agent portion of the conjugate.

VIII. LABELS

In some embodiments, the megalin ligand based active agent conjugate islabeled to facilitate its detection. A “label” or a “detectable moiety”is a composition detectable by spectroscopic, photochemical,biochemical, immunochemical, chemical, or other physical means. Forexample, labels suitable for use in the present invention include, forexample, radioactive labels (e.g., 32P), fluorophores (e.g.,fluorescein), electron dense reagents, enzymes (e.g., as commonly usedin an ELISA), biotin, digoxigenin, or haptens and proteins which can bemade detectable, e.g., by incorporating a radiolabel into the hapten orpeptide, or used to detect antibodies specifically reactive with thehapten or peptide.

As noted above, depending on the screening assay employed, the activeagent, the linker or the megalin ligand polypeptide portion of aconjugate may be labeled. The particular label or detectable group usedis not a critical aspect of the invention, as long as it does notsignificantly interfere with the biological activity of the conjugate.The detectable group can be any material having a detectable physical orchemical property. Thus, a label is any composition detectable byspectroscopic, photochemical, biochemical, immunochemical, electrical,optical or chemical means.

Examples of labels suitable for use in the present invention include,but are not limited to, fluorescent dyes (e.g., fluoresceinisothiocyanate, Texas red, rhodamine, and the like), radiolabels (e.g.,³H, ¹²⁵I, ³⁵S, ¹⁴C, or ³²P), enzymes (e.g., horse radish peroxidase,alkaline phosphatase and others commonly used in an ELISA), andcolorimetric labels such as colloidal gold or colored glass or plasticbeads (e.g., polystyrene, polypropylene, latex, etc.).

The label may be coupled directly or indirectly to the desired componentof the assay according to methods well known in the art. Preferably, thelabel in one embodiment is covalently bound to the biopolymer using anisocyanate reagent for conjugating an active agent according to theinvention. In one aspect of the invention, the bifunctional isocyanatereagents of the invention can be used to conjugate a label to abiopolymer to form a label biopolymer conjugate without an active agentattached thereto. The label biopolymer conjugate may be used as anintermediate for the synthesis of a labeled conjugate according to theinvention or may be used to detect the biopolymer conjugate. Asindicated above, a wide variety of labels can be used, with the choiceof label depending on sensitivity required, ease of conjugation with thedesired component of the assay, stability requirements, availableinstrumentation, and disposal provisions. Non-radioactive labels areoften attached by indirect means. Generally, a ligand molecule (e.g.,biotin) is covalently bound to the molecule. The ligand then binds toanother molecules (e.g., streptavidin) molecule, which is eitherinherently detectable or covalently bound to a signal system, such as adetectable enzyme, a fluorescent compound, or a chemiluminescentcompound.

The conjugates can also be conjugated directly to signal generatingcompounds, e.g., by conjugation with an enzyme or fluorophore. Enzymessuitable for use as labels include, but are not limited to, hydrolases,particularly phosphatases, esterases and glycosidases, or oxidotases,particularly peroxidases. Fluorescent compounds, i.e., fluorophores,suitable for use as labels include, but are not limited to, fluoresceinand its derivatives, rhodamine and its derivatives, dansyl,umbelliferone, etc. Further examples of suitable fluorophores include,but are not limited to, eosin, TRITC-amine, quinine, fluorescein W,acridine yellow, lissamine rhodamine, B sulfonyl chloride erythroscein,ruthenium (tris, bipyridinium), Texas Red, nicotinamide adeninedinucleotide, flavin adenine dinucleotide, etc. Chemiluminescentcompounds suitable for use as labels include, but are not limited to,luciferin and 2,3-dihydrophthalazinediones, e.g., luminol. For a reviewof various labeling or signal producing systems that can be used in themethods of the present invention, see U.S. Pat. No. 4,391,904.

Means of detecting labels are well known to those of skill in the art.Thus, for example, where the label is a radioactive label, means fordetection include a scintillation counter or photographic film as inautoradiography. Where the label is a fluorescent label, it may bedetected by exciting the fluorochrome with the appropriate wavelength oflight and detecting the resulting fluorescence. The fluorescence may bedetected visually, by the use of electronic detectors such as chargecoupled devices (CCDs) or photomultipliers and the like. Similarly,enzymatic labels may be detected by providing the appropriate substratesfor the enzyme and detecting the resulting reaction product.Colorimetric or chemiluminescent labels may be detected simply byobserving the color associated with the label. Other labeling anddetection systems suitable for use in the methods of the presentinvention will be readily apparent to those of skill in the art. Suchlabeled modulators and ligands may be used in the diagnosis of a diseaseor health condition.

The present invention provides a screening assay for megalin ligandpolypeptide-active agent conjugates, wherein the conjugates are testedfor their ability to influence a measurable activity of the megalinreceptor which can be situated in a whole cell, a cell extract,semi-purified, purified or any other format that allows for measurementof its activity. The activity can be any activity in the expression,function or degradation of megalin including, for example, the amount ortiming of such activities. Such activities include, for example,transcription, transcript processing, translation or transcriptstability of the megalin gene sequence or mRNA transcript. Suchactivities include, for example, the synthesis of new LRP, thesub-cellular localization of megalin and activation of megalinbiological activity. Such activities include, for example, the abilityof megalin to bind substances, adopt conformations, catalyze reactions,bind known ligands and the like. Such activities include, for example,the amount or stability of megalin, the processing and removal ordegradation of megalin and the like. In preferred embodiments, themegalin ligand used is one which has been modified or naturally has ahigher binding affinity for megalin than for any other LRP receptor, andparticularly a higher binding affinity for megalin than for LRP1.Screening assays similar to those discussed above for megalin may be setup for any other LRP receptors to yield a comparison of the relativebinding affinities of the megalin ligand for megalin as compared toother LRP receptors.

The invention contemplates a variety of different screening formats.Some designs are considered low throughput and test only one or a fewcompounds in series or in parallel. High throughput screening assays aresuitable for screening tens of thousands or hundreds of thousands ofcompounds in a matter of weeks or months. “In silico” screening formatsemploy computer-aided rational design techniques to identify potentialmodulators of megalin biological activity.

A. Modulating Uptake of Megalin Ligand-Conjugated Active Agents byModulating Megalin Receptor Activity

Those skilled in the art will appreciate that increasing megalinligand-active agent conjugate uptake and delivery to targets including,but not limited to, the brain or lysosomes is useful and desirable insituations such as, but not limited to, where the conjugate is beingused to treat a neurological condition and/or a LSD and increasedamounts of delivery would provide therapeutic benefit. Those skilled inthe art will appreciate that decreasing conjugate uptake and deliveryacross the blood-brain barrier is useful and desirable for a variety ofreasons including, but not limited to, where the conjugate is being usedfor its potential cardio-protective effect or used in other (non-CNS)organs and side-effects of brain uptake are to be avoided.

Suitable megalin ligands, megalin-binding fragment thereof, active agentconjugates of megalin ligands or megalin-binding fragment thereof, andmodulators of megalin and/or other LRP activity and modulators ofmegalin ligand conjugate delivery can also be readily identified using amodification of the Transwell apparatus set out in EXAMPLE 1 below. Inthe modified form, a compound (e.g., megalin ligand, a conjugate of amegalin ligand with an active agent or a modulator) is added to theluminal surface of the cells in the Transwell apparatus. The compound isthen scored according to how well it is able to traverse across theBBCECs to the abluminal side or as to how well (if a modulator) itincreases or decreases the transport of a megalin ligand or a megalinbiding fragment of a megalin ligand or another LRP ligand across theBBCECs to the abluminal side. A library of compounds can be readilyscreened or tested to identify pharmacologically superior modulators.

An exemplary ligand used herein is RAP. Other known ligands of themegalin receptor may be screened for use as modulators of the deliveryof the conjugate, or as models for designing such modulators. Theseligands include, but are not limited to, ApoE, Chylomicron remnants,β-VLDL, activated α2-macroglobulin, tPA, Tissue factor inhibitor,Pro-uPA, PAI-1, Saposin, Gentamycin, Thyroglobulin, Polymixin B, SeminalVesicle Secretory Protein A, Thrombospondin-1, Lactoferrin, and β-APP.These ligands may be modified to increase their binding affinity tomegalin. Those ligands with a greater binding affinity to megalin ascompared to LRP1 are particularly preferred.

IX. METHODS OF USING, PHARMACEUTICAL COMPOSITIONS, AND THEIRADMINISTRATION

The conjugates and modulators may be administered by a variety ofroutes. For oral preparations, the conjugates can be used alone or incombination with appropriate additives to make tablets, powders,granules or capsules, for example, with conventional additives, such aslactose, mannitol, corn starch or potato starch; with binders, such ascrystalline cellulose, cellulose derivatives, acacia, corn starch orgelatins; with disintegrators, such as corn starch, potato starch orsodium carboxymethylcellulose; with lubricants, such as talc ormagnesium stearate; and if desired, with diluents, buffering agents,moistening agents, preservatives and flavoring agents.

The conjugates and modulators can be formulated into preparations forinjection by dissolving, suspending or emulsifying them in an aqueous ornonaqueous solvent, such as vegetable or other similar oils, syntheticaliphatic acid glycerides, esters of higher aliphatic acids or propyleneglycol; and if desired, with conventional additives such assolubilizers, isotonic agents, suspending agents, emulsifying agents,stabilizers and preservatives.

The conjugates, modulators, and LRP ligands can be utilized in aerosolformulation to be administered via inhalation. The compounds of thepresent invention can be formulated into pressurized acceptablepropellants such as dichlorodifluoromethane, propane, nitrogen and thelike.

Furthermore, the conjugates and modulators can be made intosuppositories by mixing with a variety of bases such as emulsifyingbases or water-soluble bases. The compounds of the present invention canbe administered rectally via a suppository. The suppository can includevehicles such as cocoa butter, carbowaxes and polyethylene glycols,which melt at body temperature, yet are solidified at room temperature.

Unit dosage forms of the conjugate, modulator, and LRP ligand for oralor rectal administration such as syrups, elixirs, and suspensions may beprovided wherein each dosage unit, for example, teaspoonful,tablespoonful, tablet or suppository, contains a predetermined amount ofthe composition containing active agent. Similarly, unit dosage formsfor injection or intravenous administration may comprise the conjugatein a composition as a solution in sterile water, normal saline oranother pharmaceutically acceptable carrier.

In practical use, the conjugate, modulator, and LRP ligand according tothe invention can be combined as the active ingredient in intimateadmixture with a pharmaceutical carrier according to conventionalpharmaceutical compounding techniques. The carrier may take a widevariety of forms depending on the form of preparation desired foradministration, e.g., oral or parenteral (including intravenous). Inpreparing the compositions for oral dosage form, any of the usualpharmaceutical media may be employed, such as, for example, water,glycols, oils, alcohols, flavoring agents, preservatives, coloringagents and the like in the case of oral liquid preparations, such as,for example, suspensions, elixirs and solutions; or carriers such asstarches, sugars, microcrystalline cellulose, diluents, granulatingagents, lubricants, binders, disintegrating agents and the like in thecase of oral solid preparations such as, for example, powders, hard andsoft capsules and tablets, with the solid oral preparations beingpreferred over the liquid preparations.

With respect to transdermal routes of administration, methods fortransdermal administration of drugs are disclosed in Remington'sPharmaceutical Sciences, 17th Edition, (Gennaro et al. Eds. MackPublishing Co., 1985). Dermal or skin patches are a preferred means fortransdermal delivery of the conjugates, modulators, and LRP ligands ofthe invention. Patches preferably provide an absorption enhancer such asDMSO to increase the absorption of the compounds. Other methods fortransdermal drug delivery are disclosed in U.S. Pat. Nos. 5,962,012,6,261,595, and 6,261,595. Each of which is incorporated by reference inits entirety.

In specific embodiments, it is contemplated that the therapeuticadministering of the conjugates described herein will be administeredintrathecally into the CSF. The intrathecal administration of thepresent invention may comprise introducing the pharmaceuticalcomposition into a cerebral ventricle. Alternatively, the intrathecaladministration may comprise introducing the pharmaceutical compositioninto the lumbar area. In yet another alternative, the intrathecaladministration comprises introducing the pharmaceutical composition intothe cisterna magna. Any such administration is preferably via a bolusinjection. Depending on the severity of the symptoms and theresponsiveness of the subject to the therapy, such a bolus injection maybe administered once per week, once per month, once every 6 months orannually. In other embodiments, the intrathecal administration isachieved by use of an infusion pump. The pharmaceutical could of coursebe intrathecally administered continually over a period of at leastseveral days or alternatively, the intrathecal administration iscontinually over a period of at least four weeks. Of course, where theadministration is via continuous infusion, the rate of doseadministration of the enzyme replacement therapy may be greatly reducedas compared to the bolus injection administration. In preferredembodiments, the active agent of the conjugate is iduronidase and it isdelivered in an amount that comprises about 1 mg iduronidase/20 kg ofbody weight of the mammal being treated for MPS. In particularembodiments, the above dose is delivered to 15 cc CSF. At such aconcentration it is contemplated that the enzyme concentration will be18,000 units per ml of CSF. It should be understood that theaforementioned dosage is merely an exemplary dosage and those of skillin the art will understand that this dosage may be varied.

The methods and compositions of the invention may be combined withmethods and compositions of inducing antigen specific tolerance prior tothe enzyme replacement therapy. Such methods include inducing antigenspecific tolerance comprises administration of an immunosuppressiveagent, such as e.g., cyclosporine A and may further compriseadministration of an antiproliferative agent, including but not limitedto a nucleotide analog or an anti-metabolite. The antiproliferativeagent may be azathioprine. Further methods are described in e.g., U.S.patent application Ser. No. 10/141,668, published as U.S. PublicationNo. 20030211113; and U.S. patent application Ser. No. 10/429,314published as U.S. Publication No. 20040009906, each incorporated hereinby reference.

Pharmaceutically acceptable excipients, such as vehicles, adjuvants,carriers or diluents, are commercially available. Moreover,pharmaceutically acceptable auxiliary substances, such as pH adjustingand buffering agents, tonicity adjusting agents, stabilizers, wettingagents and the like, are commercially available.

Those of skill will readily appreciate that dose levels can vary as afunction of the specific compound, the severity of the symptoms and thesusceptibility of the subject to side effects. Preferred dosages for agiven compound are readily determinable by those of skill in the art bya variety of means, including, but not limited to dose response andpharmacokinetic assessments conducted in patients, test animals, and invitro.

In each of these aspects, the compositions include, but are not limitedto, compositions suitable for oral, rectal, topical, parenteral(including subcutaneous, intramuscular, and intravenous), pulmonary(nasal or buccal inhalation), or nasal administration, although the mostsuitable route in any given case will depend in part on the nature andseverity of the conditions being treated and on the nature of the activeingredient. Exemplary routes of administration are the oral andintravenous routes. The compositions may be conveniently presented inunit dosage form and prepared by any of the methods well-known in theart of pharmacy.

In practical use, the modulators or according to the invention can becombined as the active ingredient in intimate admixture with apharmaceutical carrier according to conventional pharmaceuticalcompounding techniques. The carrier may take a wide variety of formsdepending on the form of preparation desired for administration, e.g.,oral or parenteral (including intravenous). In preparing thecompositions for oral dosage form, any of the usual pharmaceutical mediamay be employed, such as, for example, water, glycols, oils, alcohols,flavoring agents, preservatives, coloring agents and the like in thecase of oral liquid preparations, such as, for example, suspensions,elixirs and solutions; or carriers such as starches, sugars,microcrystalline cellulose, diluents, granulating agents, lubricants,binders, disintegrating agents and the like in the case of oral solidpreparations such as, for example, powders, hard and soft capsules andtablets, with the solid oral preparations being preferred over theliquid preparations.

Because of their ease of administration, tablets and capsules representthe most advantageous oral dosage unit form in which case solidpharmaceutical carriers are obviously employed. If desired, tablets maybe coated by standard aqueous or nonaqueous techniques. The percentageof an active compound in these compositions may, of course, be variedand may conveniently be between about 2 percent to about 60 percent ofthe weight of the unit.

The conjugates, modulators, and ligands of the invention are useful fortherapeutic, prophylactic and diagnostic intervention in animals, and inparticular in humans. As described herein, the conjugates showpreferential accumulation and/or release of the active agent in anytarget organ, compartment, or site depending upon the biopolymer used.

Compositions of the present invention may be administered encapsulatedin or attached to viral envelopes or vesicles, or incorporated intocells. Vesicles are micellular particles which are usually spherical andwhich are frequently lipidic. Liposomes are vesicles formed from abilayer membrane. Suitable vesicles include, but are not limited to,unilamellar vesicles and multilamellar lipid vesicles or liposomes. Suchvesicles and liposomes may be made from a wide range of lipid orphospholipid compounds, such as phosphatidylcholine, phosphatidic acid,phosphatidylserine, phosphatidylethanolamine, sphingomyelin,glycolipids, gangliosides, etc. using standard techniques, such as thosedescribed in, e.g., U.S. Pat. No. 4,394,448. Such vesicles or liposomesmay be used to administer compounds intracellularly and to delivercompounds to the target organs. Controlled release of a p97-compositionof interest may also be achieved using encapsulation (see, e.g., U.S.Pat. No. 5,186,941).

Any route of administration that delivers the megalin ligand-basedactive agent conjugate or modulator composition into the blood stream,or preferably at least outside of the blood-brain barrier, may be used.Preferably, the composition is administered peripherally, mostpreferably intravenously or by cardiac catheter. Intrajugular andintracarotid injections are also useful. Compositions may beadministered locally or regionally, such as intraperitoneally orsubcutaneously on intramuscularly. In one aspect, compositions areadministered with a suitable pharmaceutical diluent or carrier.

Dosages to be administered will depend on individual needs, on thedesired effect, the active agent used, the biopolymer and on the chosenroute of administration. Preferred dosages of a conjugate range fromabout 0.2 μmol kg to about 25 nmol kg, and particularly preferreddosages range from 2-250 μmol/kg; alternatively, preferred doses of theconjugate may be in the range of 0.02 to 2000 mg/kg. These dosages willbe influenced by the number of active agent or drug moieties associatedwith the biopolymer. Alternatively, dosages may be calculated based onthe active agent administered.

In preferred embodiments the conjugate comprises human RAP. Forinstance, doses of RAP-adriamycin comprising from 0.005 to 100 mg/kg ofadriamycin are also useful in vivo. Particularly preferred is a dosageof RAP-adriamycin comprising from 0.05 mg/kg to 20 mg/kg of adriamycin.Those skilled in the art can determine suitable doses for compoundslinked to a megalin ligand based in part on the recommended dosage usedfor the free form of the compound. Conjugation of the active agent to amegalin ligand such as RAP generally reduces the amount of drug neededto obtain the same effect.

The conjugates and modulators of the invention are useful fortherapeutic, prophylactic and diagnostic intervention in animals, and inparticular in humans. Megalin ligand compounds may show preferentialaccumulation in particular tissues. Preferred medical indications fordiagnostic uses include, for example, any condition associated with atarget organ of interest (e.g., lung, liver, kidney, spleen). Inparticularly preferred embodiments, the target organ of interest in thebrain.

The subject methods find use in the treatment of a variety of differentdisease conditions. In certain embodiments, of particular interest isthe use of the subject methods in disease conditions where an activeagent or drug having desired activity has been previously identified,but in which the active agent or drug is not adequately delivered to thetarget site, area or compartment to produce a fully satisfactorytherapeutic result. With such active agents or drugs, the subjectmethods of conjugating the active agent to a megalin ligand or a megalinbinding fragment thereof can be used to enhance the therapeutic efficacyand therapeutic index of active agent or drug.

The specific disease conditions treatable by with the subject conjugatesare as varied as the types of drug moieties that can be present in theconjugate. Thus, disease conditions include cellular proliferativediseases, such as neoplastic diseases, autoimmune diseases,cardiovascular diseases, hormonal abnormality diseases, degenerativediseases, diseases of aging, diseases of the central nervous system(e.g., Alzheimer's disease, epilepsy, hyperlipidemias), psychiatricdiseases and conditions (e.g., schizophrenia, mood disorders such asdepression and anxiety), infectious diseases, enzyme deficiencydiseases, lysosomal storage diseases such as those described above, andthe like.

Treatment is meant to encompass any beneficial outcome to a subjectassociated with administration of a conjugate including a reducedlikelihood of acquiring a disease, prevention of a disease, slowing,stopping or reversing, the progression of a disease or an ameliorationof the symptoms associated with the disease condition afflicting thehost, where amelioration or benefit is used in a broad sense to refer toat least a reduction in the magnitude of a parameter, e.g., symptom,associated with the pathological condition being treated, such asinflammation and pain associated therewith. As such, treatment alsoincludes situations where the pathological condition, or at leastsymptoms associated therewith, are completely inhibited, e.g., preventedfrom happening, or stopped, e.g., terminated, such that the host nolonger suffers from the pathological condition, or at least the symptomsthat characterize the pathological condition.

In specific embodiments, the disorder being treated is a lysosomalstorage disease and the conjugate is administered as a pharmaceuticalcomposition in an amount effective to decrease the amount of storagegranules present in the brain tissue of said mammal. Typically, thesymptoms of such a disorder are monitored through routine assessment ofhistory, physical examination, echocardiography, electrocardiography,magnetic resonance imaging, polysomnography, skeletal survey, range ofmotion measurements, corneal photographs, and skin biopsy.Administration of a megalin-binding moiety conjugated to a therapeuticagent in such a disorder results in normalization of developmental delayand regression in said subject, reduction in high pressurehydrocephalus, reduction in spinal cord compression in said subject, andreduction in number and/or size of perivascular cysts around the brainvessels of said subject. Methods of monitoring and assessing suchsequelae are known to those of skill in the art. Those of skill in theart are referred to U.S. Pat. No. 6,585,971; U.S. Pat. No. 6,569,661 andU.S. Pat. No. 6,426,208 and U.S. Patent Publication No. 20040009906 foradditional descriptions of such sequelae.

In some aspects, it may be useful to increase the tolerance of theanimal to the therapy being delivered. Such methods are described inU.S. patent application Ser. No. 10/429,314 filed May 5, 2003 andpublished as 20040009906 (incorporated herein by reference in itsentirety).

In preferred embodiments, the animal is suffering frommucopolysaccharidosis I and has about 50% or less of a normalα-L-iduronidase activity. In such embodiments, it would be desirable toadministered an effective dose of between about 0.001 mg/kg body weightand 0.5 mg/kg body weight of human α-L-iduronidase as part of theconjugate e.g., weekly to a subject suffering from a deficiency thereof.In other embodiments, the subject is given a dose of between about 0.01mg/15 cc of CSF to about 5.0 mg/15 cc of CSF in the mammal of said humanα-L-iduronidase weekly. The therapies contemplated herein promote thebreakdown of glycosaminoglycan (GAG) in a brain cell of a subject havinglysosomal storage disease. The brain cell may be a neuron, a neuroglialcell, an ependymal cell. Typically, the brain cells in which granuleaccumulation occurs and should be ameliorated by administering aconjugate of the invention include neurons, glial cells, microglialcells, astrocytes, oligodendroglial cells, perivascular cells,perithelial cells, meningeal cells, ependymal cells, arachnoidgranulation cells, arachnoid membranes, dura mater, pia mater andchoroid plexus cells. The therapy in preferred embodiments reducesstorage granules in meningeal cells as compared to the number oflysosomal storage granules present in a similar cell in the absence ofadministration of said conjugate. This produces the therapeutic effectsof relieving the symptoms of high pressure hydrocephalus in somesubjects. and said administering reduces the amount of CSF fluid in themeningeal tissue of said subject.

A variety of hosts or subjects are treatable according to the subjectmethods. Generally such hosts are “mammals” or “mammalian,” where theseterms are used broadly to describe organisms which are within the classmammalia, including the orders carnivore (e.g., dogs and cats), rodentia(e.g., mice, guinea pigs, and rats), and primates (e.g., humans,chimpanzees, and monkeys). In many embodiments, the hosts will behumans.

XI. PRODUCTION OF MEGALIN LIGAND POLYPEPTIDES

In the present invention, numerous megalin ligands may be used tofacilitate transcytosis of a given active agent. One exemplary suchligand is RAP. RAP and RAP polypeptides for use according to theinvention include those disclosed in U.S. Pat. No. 5,474,766 that isenclosed herein by reference in its entirety for the purposes ofdisclosing such peptides and how they may be obtained for use in thecompounds and compositions of the present invention. RAP, and RAPpolypeptides, and other megalin ligands may be produced using any ofprotein preparation and purification methods known to those of skill inthe art.

The ligand can be purified from a naturally occurring source of theprotein, can be isolated from a recombinant host expressing the ligand,or can be synthesized using well known techniques in protein synthesis.A skilled artisan can readily adapt a variety of such techniques inorder to obtain a megalin ligand that contain the megalin binding site.Such a megalin ligand may for example possess the megalindocking/binding site found on RAP. See, for instance, Melman et al., J.Biol. Chem. 276 (31): 29338-29346 (2001); Savonen et al., J Biol. Chem.274(36): 25877-25882 (1999); Nielsen et al. Proc. Natl. Acad. Sci. USA94:7521-7525 (1997); Medved et al., J. Biol. Chem. 274(2): 717-727(1999); Rall et al., J. Biol. Chem. 273(37): 24152-24157 (1998); Orlandoet al., Proc. Natl. Acad. Sci. USA 3161-3163 (1994).

The isolation of native RAP proteins has been described in Ashcom etal., J. Cell. Biol. 110:1041-1048 (1990) and Jensen et al., FEBS Lett.255:275-280 (1989). Megalin ligand fragments containing the megalinbinding site may be generated from isolated native protein which isconverted by enzymatic and/or chemical cleavage to generate fragments ofthe whole protein. Exemplary such methods are taught in U.S. Pat. No.6,447,775 which is herein incorporated by reference with particularreference to such methods for obtaining RAP polypeptides.

In addition, the megalin ligand or a megalin binding fragment of such aligand can be expressed in a recombinant bacteria, as described, byWilliams et al., J. Biol. Chem. 267:9035-9040 (1992) and Wurshawsky etal., J. Biol. Chem. 269:3325-3330 (1994).

As indicated herein throughout, RAP is a preferred megalin ligand.Procedures for purifying the 39 kDa RAP protein from a recombinant E.coli strain has been previously described by Herz et al., J. Biol. Chem.266, 21232-21238 (1991). A modified version of that procedure can beused as described in U.S. Pat. No. 5,474,766 and below.

Cultures of E. coli strain DHSalpha carrying the expression plasmidpGEX-39 kDa can be grown to mid-log phase in LB medium with 100 μg/mlampicillin at 37° C. Cultures can then be cooled to 30° C. andsupplemented with 0.01% isopropylthio-beta-D-galactoside to induceexpression of the glutathione-S-transferase-39 kDa fusion protein.Following a 4-6 hour induction at 30° C., cultures can be cooled withice and recovered by centrifugation.

All of the following steps are to be carried out at 4° C. Cell pelletsare lysed in PBS with 1% Triton X-100, 1 μM pepstatin, 2.5 μg/mlleupeptin, 0.2 mM phenylmethylsulfonyl fluoride (PMSF), and 1 μMethylenediaminetetraacetate (EDTA). Sonication of this lysate with aBranson Model 450 Sonifier with separation of the resulting membranesand other cellular debris by centrifugation at 15,000 g for 15 minutesis then followed by retrieval of the supernatant. The supernatant fromthis step is incubated overnight with agarose immobilized glutathionebeads (Sigma Chemical Co.) in PBS and 0.1% sodium azide. The beads canthen be washed, and elution of the fusion protein can be carried out bycompetition with 5 mM reduced glutathione (Sigma Chemical Co.).Following dialysis, the fusion protein can be cleaved by an overnightincubation with 100 ng of activated human thrombin per 50 μg of fusionprotein. The glutathione-5-transferase epitope can subsequently beremoved by further incubation with agarose immobilized glutathionebeads.

The 28 kDa protein fragment of the 39 kDa protein (“28 kDa protein”) ofthe present invention has the following amino acid sequence set forth inthe Sequence Listing as SEQ ID NO:2 (FIG. 16).

The 28 kDa protein has a molecular weight of 28,000 daltons on SDS-PAGE,is relatively stabile to acid hydrolysis, is soluble in 1% Triton X-100,and has approximately the same inhibitory activity (Ki) on t-PA bindingto the hepatic receptor as the 39 kDa protein. The 28 kDa protein may becloned and purified as further exemplified in U.S. Pat. No. 5,474,766which is expressly incorporated herein by reference for such methods ofcloning.

While the above method is described for the production and purificationof RAP, as indicated above, other megalin ligands and megalin bindingfragments also may be produced using similar techniques. A review ofsuch ligands may be found in Christensen and Bim, (Am. J. Physiol. RenalPhysiol., 280:F562-F573, 2001, see particularly Table 1 and referencescited therein) Techniques for making and purifying such ligands are wellknown to those of skill in the art.

XI. EXAMPLES

The following example(s) is included to demonstrate preferredembodiments of the invention. It should be appreciated by those of skillin the art that the techniques disclosed in the example(s) that followsrepresent techniques discovered by the inventor to function well in thepractice of the invention, and thus can be considered to constitutepreferred modes for its practice. However, those of skill in the artshould, in light of the present disclosure, appreciate that many changescan be made in the specific embodiments which are disclosed and stillobtain a like or similar result without departing from the spirit andscope of the invention. The following examples provide exemplaryprotocols for assessing transcytosis in vitro and for characterizing theinteraction of megalin ligands such as RAP with megalin and otherreceptors.

Example 1 Transcytosis of p97

Transcytosis experiments were performed as follows. One insert coveredwith bovine brain capillary endothelial cells (BBCECs) was set into aTranswell apparatus containing a six-well microplate with 2 ml ofRinger/Hepes and pre-incubated for 2 h at 37° C. ¹²⁵I-p97 (250 nM) wasadded to the upper side of the filter covered with cells. At varioustimes, the insert was transferred to avoid re-endocytosis of p97 by theabluminal side of the BBCECs. At the end of experiment, [¹²⁵I]-p97 wasmeasured after TCA precipitation. Transcytosis is depicted in FIG. 17.

The effect of RAP on transcytosis of ¹²⁵I-p97 was assessed. In FIG. 1,RAP, a known polypeptide inhibitor of the LRP family was applied to thecells (25 micrograms/ml). RAP significantly inhibited the transcytosisof p97, thus directly implicating the LRP family in transcytosis.

Example 2 Construction, Expression, Purification and Characterization ofRAP Fusions

Expression constructs encoding fusions between the humanreceptor-associated protein (RAP) and human alpha-glucosidase (GAA),alpha-L-iduronidase (IDU) or glial cell-derived neurotrophic factor(GDNF) were prepared. For this purpose, a sequence that encodes RAP wasfused to the 5′-end of sequences that encode the different fusionpartners. All sequences were obtained by high-fidelity PCR amplificationof human cDNA with the following primers shown in FIG. 2 a. The GDNFfusion was designed for expression in bacteria. To this end, primerRAPBACF was substituted for RAPF in the RAP amplification for thisconstruct (FIG. 2 b).

The 5′-end of RAP was truncated to remove the signal peptide sequence.Instead, an in-frame BamHI site, which encodes the dipeptide GS, wasadded for the mammalian expression construct. Sequence encoding thetetrapeptide MGGS with an NcoI site at the 5′-end was added for thebacterial expression construct. The 3′-end of RAP was truncated toremove the tetrapeptide HNEL endoplasmic reticulum retention signal.Instead, the coding sequence for a six amino-acid spacer (AEAETG) wasappended. The last two codons of the spacer specify an AgeI restrictionsite. The 5′-end of GAA was truncated to remove the signal peptide andpro-peptide sequences (Wisselaar, et al., J. Biol. Chem. 268(3):2223-31,1993). Instead, an AgeI site was added to permit fusion to theRAP-spacer portion of the fusion. The 5′-end of IDU was similarlytruncated to remove the signal peptide and introduce the restrictionsite. The 5′-end of GDNF was truncated to remove both the signal peptideand pro-peptide sequences (Lin et al., Science, 260(5111): 1130-2,1993).

The open-reading frames encoding the GAA and IDU fusions were ligatedinto the expression vector pCINmt using flanking BamHI and XhoI sites.The vector contains the human melanotransferrin signal peptide with anin-frame BamHI site at the 3′-end. The sequences of the resulting fusionproteins are shown in FIGS. 3 and 4. The pCINmt (derived from Invitrogenvector pcDNA3.1) control sequences consist of the human CMV promoterfollowed by the rabbit IVS2 and the rat preproinsulin RNA leadersequence. A bovine growth hormone terminator sequence is positioned atthe 3′-end of the expression cassette. The vector includes a selectablemarker composed of an attenuated neomycin phosphotransferase gene drivenby the weak HSV-tk promoter (Yenofsky et al., Proc. Nat'l Acad. Sci.,USA 87(9):3435-9, 1990). Expression constructs for RAP-GAA and RAP-IDUwere transfected into an Lrp-deficient CHO cell line (CHO13-5-1) andrecombinants selected with 800 μg/mL G418.

The RAPGDNF fusion (FIG. 5) was cloned into the bacterial expressionvector pBADhisA (Invitrogen) using the flanking NcoI and XbaI sites. Theresulting expression vector was transfected into BL21 cells andrecombinants selected with carbenicillin. Expressed, purified RAP-GDNFfusion may be assayed for the ability to protect dopaminergic neurons orother activities as previously described (Kilic et al., Stroke34(5):1304-10, 2003).

Expression of RAP Fusions

Culture medium was JRH 302 supplemented with 2 mM L-glutamine,gentamycin, amphotericin, 800 μg/mL G418 and 2.5% fetal calf serum.Recombinant clones were grown in T225 flasks prior to seeding into 1 LCorning spinner flasks on Cytopore 1 beads (Amersham) in the presence ofserum. Spinner flasks were maintained in a tissue culture incubator setat 37° C. and 5% CO₂. Medium was replaced every two days with serum-freemedium until serum levels were undetectable. Subsequently, harvests werecollected every two days and medium exchanged.

Purification of RAP-GAA for Uptake Assay:

RAP-GAA harvested in the medium from the spinner flasks was applied to aBlue-Sepharose column (Amersham) in low-salt buffer at neutral pH.Fusion was eluted with a linear salt gradient, and fractions containingfusion were loaded to a Heparin-Sepharose column (Amersham) and againeluted with a linear salt gradient. Eluted fractions containing activitywere pooled and applied to a Phenyl-Sepharose column (Amersham). RAP-GAAwas eluted from the Phenyl-Sepharose column with a decreasing salt stepgradient. Eluted fractions were run on an SDS-PAGE gel and stained todetermine relative percent purity. Based on gel analysis, peak activityfractions were about 70% pure. Fractions were pooled, concentrated usinga 30 kD MWCO membrane (Millipore), and exchanged into phosphate-bufferedsaline at neutral pH.

The activity of the lysosomal enzyme in the fusion was determined to beunaffected by fusion to RAP. Purified human LRP (1 μg, recombinant,binding domain 2) was spotted onto PVDF filters in a 96-well dot-blotapparatus. Purified RAP-lysosomal enzyme fusion (RAP-LE) inTris-buffered saline pH 7.5 with 5 mM CaCl₂ and 3% non-fat dry milk(TBS/Ca/BLOTTO) was overlayed on the immobilized LRP. Conditioned mediumcontaining the RAP-LE, buffer alone and RAP alone were similarlyincubated with immobilized LRP. Filters were washed three times toremove unbound protein. Duplicate filters were probed with anti-LEantibody or anti-RAP antibody. Blots were developed withchemiluminescent detection. The activity of the lysosomal enzyme wasmeasured using fluorescent substrates. It was observed as shown in FIG.10 that antibodies to either RAP or to the lysosomal enzyme detectLRP-bound RAP-LE, were found to bind to the fusion on Western blots,indicating that the fused proteins were intact and folded. Comparingsignal intensity, it is further observed that the fusion is bound by theimmobilized LRP to a similar extent as RAP alone.

Characterization of RAP-GAA Fusion:

Purified RAP-GAA was tested to determine identity, purity andcarbohydrate content. For the identity test, fusion was resolved onSDS-PAGE, blotted to PVDF and probed with anti-GAA and anti-RAPantibodies. A single band of about 150 kD cross-reacted with bothantibodies (FIG. 6). Fusion purity was determined by Coomassie Bluestaining of the SDS-PAGE gel and was estimated to be >95%. Presence ofcomplex oligosaccharides was measured by digestion with neuraminidaseand comparison to undigested samples on an IEF gel. Neuraminidasedigestion resulted in a quantitative shift in mobility to a more basicpI, consistent with the presence of complex oligosaccharides (FIG. 7).Endo H digestion was used to test for the presence of high-mannoseoligosaccharides. Unlike control proteins, no change in molecular weightof the fusion was observed on SDS-PAGE gels after Endo H digestion. Thissuggests the absence of high-mannose oligosaccharides on the fusion(FIG. 8).

Purification of the RAP-IDU Fusion:

Blue sepharose 6 Fast Flow resin is used for the first purificationstep. The harvest fluid was adjusted to pH 7.0 and loaded onto aBlue-Sepharose column at a 70 mL/mL resin basis. The column wasequilibrated with 75 mM NaCl, 20 mM Na₂HPO₄ pH 7.0. RAP-IDU eluted offthe column at 1.2 M NaCl, 20 mM Na₂HPO₄ pH 7.0. The eluted fractioncontaining RAP-IDU (determined by iduronidase activity assay) was thenexchanged into 75 mM NaCl, 20 mM Na₂PO₄ pH 7.0 and loaded onto a HeparinCL 6B resin. RAP-IDU was eluted from the Heparin column at 0.5 M NaCl pH7.0. The eluted fusion was then adjusted to 2M NaCl, 20 mM Na₂HPO₄ pH7.0 and loaded directly onto a Phenyl-Sepharose column. As a final step,RAP-IDU was eluted from this column at between 0.3 to 0.5M NaCl. Fusionpurity was estimated by SDS-PAGE at >80% (FIG. 9).

Example 3 Uptake and Distribution of Unconjugated RAP to the Brain

The distribution of RAP to brain was measured using a mouse in situperfusion model. Volumes of distribution (Vd) for RAP, the positivecontrol transferrin and the negative control albumin, were determinedover a perfusion interval of 5 minutes. In addition, the relativequantities of the test proteins in the vascular and parenchymalfractions of the perfused brain were determined using the capillarydepletion technique (Gutierrez et al., J. Neuroimmunol., 47(2):169-76,1993). The results shown in FIG. 11 include an observed, correctedKinflx of 1 μL/g/min for transferrin. RAP had an observed, correctedK_(influx) of 2.2 μL/g/min. RAP is taken up into brain.

A separate experiment was carried out at a single, 5-minute time-pointto determine whether RAP is able to traverse the brain vasculature andenter the parenchyma. Brains were harvested as before, but weresubjected to a capillary depletion procedure to determine the levels ofRAP and albumin in the vascular and parenchymal spaces. Followingharvest, the isolated cortex was weighed and placed in a Douncehomogenizer on ice. The cortex was immediately homogenized in 0.7 ml ofcapillary buffer (10 mM HEPES, 141 mM NaCl, 4 mM KCl, 2.8 mM CaCl₂, 1 mMNaH₂PO₄, 1 mM MgSO₄, 10 mM glucose, pH 7.4) for 10 strokes, after which1.7 ml of 26% dextran was added and the mixture further homogenized withan additional 3 strokes on ice. To separate the different tissuefractions, 1.3 ml of the homogenate was loaded in an ultracentrifugetube. The homogenate was centrifuged at 9000 rpm (5400×g) for 15 min at4° C. in a Beckman TLV-100 swinging-bucket rotor. The parenchymalportion (supernatant) and the capillary portion (pellet) were thanseparately counted in a dual-channel gamma counter. A sample of post-CNSperfusate was also counted for the Vd calculation. Unlabeled RAP wasincluded as a competitor in some cases to determine whether uptake intobrain tissue was saturable (5 μg of unlabeled RAP per mouse, about80-fold excess over labeled RAP). Results were plotted as corrected Vd(FIG. 11). Each data point is an average derived from 5-6 mice. FIG. 12shows the distribution of RAP between brain capillary endothelium andbrain parenchyma. These results indicate RAP crosses the blood-brainbarnier to enter brain parenchyma and that the process of uptake issaturable.

Example 4 Measurement of Specific Uptake of RAP-GAA intoEnzyme-Deficient Patient Fibroblasts

The uptake of RAGA into cells deficient in GAA was characterized. Thecell line used was GM244 (Coriell Cell Repository), a primary cell lineisolated from a patient with glycogen storage disorder type II (Pompe'sdisease). These fibroblasts take up phosphorylated, recombinant GAA viathe mannose-6-phosphate receptor, but also have LRP1 receptors, whichbind RAP. In order to identify the receptors involved in uptake ofdifferent test ligands, samples containing excess free RAP ormannose-6-phosphate were prepared.

Dilutions of RAP-GAA were made in the uptake medium (Dulbecco's ModifiedEagle's Medium supplemented with 25 mM HEPES pH 7.0, 2 mM L-glutamineand 250 μg/mL bovine serum albumin) to yield fusion proteinconcentrations of 33, 11, 3.7, 1.2, 0.4, and 0.1 nM. The effect of 3 mMmannose-6-phosphate, 500 nM RAP and a combination of the two on theuptake of 5 nM RAP-GAA was also assayed. The GM244 fibroblasts wasseeded into 12-well plates and allowed to grow for 3 days prior to theuptake experiment.

To initiate uptake, the growth medium was aspirated from the wells andeach sample dispensed into duplicate wells at 1 ml per well. Plates wereincubated for 4 hours at 37° C., 5% CO₂. Samples were then aspiratedfrom each well, the wells washed with phosphate-buffered saline (PBS),and pre-warmed 0.25% trypsin/0.1% EDTA added to each well at 370 for 5minutes to release the adherent cells. Released cells were pelleted andrinsed with chilled PBS. Pre-chilled lysis buffer (phosphate-citratebuffer, pH 4.0 with 0.15% Triton X-100) was then added and the pelletsresuspended by gentle vortexing. Lysed cells could be stored at −80° C.

To measure the levels of GAA activity in the lysed cells, the frozenlysates were thawed at room temperature. Lysate (50 μl) was addeddirectly to duplicate wells in 96-well opaque microtiter plates.Pre-warmed GAA fluorescent substrate(4-methylumbelliferyl-alpha-D-glucoside, 100 μL) was added to each wellto initiate the reaction. The plate was incubated at 37° C. for 30minutes and the reaction terminated by addition of 150 μlglycine/carbonate buffer pH 10. Fluorescence was measured in a platereader at an excitation wavelength of 366 nm and an emission wavelengthof 446 nm.

The results in FIG. 13 show that RAP-GAA is taken up by GM244 fibroblastcells. The K_(uptake) was ˜19 nM as determined by a non-linear fitenzymatic algorithm described in the GraFit software program (Sando andNeufeld, Cell, 12(3):619-27, 1977). Approximately 60-fold more RAP-GAAgets into the fibroblasts than recombinant GAA (V_(max) ratio); 25-foldmore at 10 nM. Additionally, 90% of the RAP-GAA fusion uptake isinhibited by 50 nM RAP while only 20% of the uptake is inhibited by 3 mMmannose 6-phosphate. The uptake of the native GAA is almost completelyinhibited by mannose 6-phosphate, suggesting alternate receptor pathwaysfor RAP-GAA and recombinant GAA.

Example 5 Measurement of RAP-GAA Uptake and Lysosomal Localization inLRPnuII CHO Cells Expressing Different LRP Receptor Family Members(LRP1B, LDLR, VLDLR) and into BN Cells Expressing only LRP2 (Megalin,gp330)

Iodine labeling: RAP-GAA or recombinant GAA were radiolabeled with ¹²⁵Iusing the IODO-GEN reagent.

Cells were seeded in 12-well plates at a density of 200,000 cells/welland used after overnight culture. On the day of the experiment, cellswere rinsed twice in ice-cold ligand binding buffer (Minimal Eagletsmedium containing 0.6% bovine serum albumin; BSA), and ¹²⁵I-RAP-GAA orGAA alone were then added in the same buffer (0.5 ml/well). The initialligand concentrations tested were 10 nM. Binding was carried out at 4°C. for 30 min with gentle rocking in the presence or absence ofunlabeled 500 nM RAP or 10 mM mannose-6-phosphate to confirmreceptor-binding specificity. Unbound ligand was then removed by washingcell monolayers three times with ice-cold binding buffer. Ice-coldstop/strip solution (0.2 M acetic acid, pH 2.6, 0.1 M NaCl) was thenadded to one set of plates without warming and kept on ice prior tocounting. Dissociation constants for the receptor-ligand complexes weredetermined from the resulting binding data. The remaining plates werethen placed in a 37° C. water bath, and 0.5 ml of ligand binding bufferprewarmed to 37° C. was added to the well monolayers to initiateinternalization. At each time point (every 30 seconds for 2 minutes andevery 3 minutes thereafter) the wells were placed on ice, and theligand-binding buffer replaced with ice-cold stop/strip solution. Ligandthat remained on the cell surface was stripped by incubation for 20minutes (0.75 ml for 10 minutes, twice) and counted. Internalizationrates were determined from this data. Cell monolayers were thensolubilized with SDS lysis buffer (62.5 mM Tris-HCl, pH 6.8, 0.2% SDS,and 10% (v/v) glycerol) and counted. The sum of ligand that wasinternalized added to that which remained on the cell surface after eachassay was used as the maximum potential internalization. The fraction ofinternalized ligand after each time point was calculated and plotted.

Measurement of ligand degradation efficiency (transport to lysosomesafter internalization): Cells were seeded at a density of 200,000cells/well into 12-well dishes 1 day prior to assays. On the day of theexperiment, pre-warmed assay buffer containing RAP-GAA or GAA alone wasadded to cell monolayers in the presence or absence of unlabeled 500 nMRAP or 10 mM mannose 6-phosphate, followed by incubation for 4 hours at37° C. Following incubation, the medium overlaying the cell monolayerswas removed and proteins were precipitated by addition of BSA to 10mg/ml and trichloroacetic acid to a final concentration of 20%.Lysosomal degradation of ligands was defined as the appearance ofradioactive fragments in the medium that were soluble in 20%trichloroacetic acid. The protein concentrations of each cell lysatewere measured in parallel dishes that did not contain LRP ligands. TheRAP-GAA and GAA degradation efficiencies were calculated as the value ofdegraded radioactive material (soluble cpm/mg cell protein) divided bythe number of cell surface LRP family receptors (as determinedpreviously by flow cytometry, data not shown).

Example 6 Measurement of Specific Uptake of RAP-LE in toEnzyme-Deficient Patient Fibroblasts with Concomitant Clearance ofStored Glycosaminoglycans

Patient fibroblasts are seeded and grown to confluence in 12-wellplates. On the day of the experiment, cells are fed with fresh mediumlacking MgSO₄ and containing 4 μCi/mL of Na₂ ³⁵SO₄. Cells are alsosupplemented with RAP-LE fusion or LE alone in the presence or absenceof 500 nM RAP or 10 mM mannose 6-phosphate. Cells are harvested each dayfor 4 days. After rinsing with PBS, cells are lysed by freeze-thaw.Stored GAG is assayed by precipitation with 80% ethanol and quantitatedby scintillation counting. Stored GAG values are normalized to theprotein content of the cell lysates.

Example 7 Measurement of Lysosomal Distribution and Clearance of Storagein Intravenously-Administered RAP-GAA in GAA-Deficient Mice

GAA knock out mice (C57B1/6 background) were randomized to fourtreatment groups and treated every two days with 100 μl of eitherphosphate-buffered saline, 1.3 mg/kg or 0.33 mg/kg RAP-GAA fusionprotein four times via intravenous tail vein injection. Forty-eighthours after the fourth injection, mice were euthanized by carbon dioxideinhalation and the brain, heart, diaphragm, upper and lower bodyskeletal muscle and liver immediately collected and flash frozen. Threeage-matched wild-type mice were also euthanized and tissues collectedand frozen. Each tissue is prepared for GAA immunohistochemical stainingby embedding in OCT blocks, and for glycogen staining by fixing inglutaraldehyde and embedding in paraffin. The remaining tissues weretested for GAA activity using the fluorescent substrate assay describedin Example 4. Serum was collected at sacrifice and tested for GAAantibody.

Dosing Regimen

Test Articles Dose Or Vehicle Dose Volume Group #Animals Articles(mg/kg) #Doses (μl) 1 6 KO PBS — 4 100 2 6 KO RAP-GAA 0.33 4 100 3 6 KORAP-GAA 1.30 4 100 4 6 KO GAA 1.30 4 100 5 3 WT None None None None

Study day 0 Inject groups 1-4 Study day 2 Inject groups 1-4 Study day 4Inject groups 1-4 Study day 7 Inject groups 1-4 Study day 9 Bleed groups1-4 and Sacrifice groups 1-5, Collect tissues groups 1-5

Example 8 Treatment of Patients with MPS-I Disorder

A pharmaceutical composition comprising a conjugated agent comprisingtherapeutic enzyme linked to RAP is administered intravenously. Thefinal dosage form of the fluid includes the conjugated agent, normalsaline, phosphate buffer at pH 5.8 and human albumin at 1 mg/ml. Theseare prepared in a bag of normal saline.

A preferred composition comprises the conjugated agent (therapeuticenzyme linked to RAP) in an amount ranging from 0.05-0.5 mg/mL or12,500-50,000 units per mL; sodium chloride solution 150 mM; sodiumphosphate buffer 10-50 mM, pH 5.8; human albumin 1 mg/mL. Thecomposition may be in an intravenous bag of 50 to 250 ml.

Human patients manifesting a clinical phenotype of deficiency oflysosomal enzyme, such as in patients with MPS I with analpha-L-iduronidase level of less than 1% of normal in leukocytes andfibroblasts are included in the study. All patients manifest someclinical evidence of visceral and soft tissue accumulation ofglycosaminoglycans with varying degrees of functional impairment.Efficacy is determined by measuring the percentage reduction in urinaryGAG excretion over time. The urinary GAG levels in MPS-I patients arecompared to normal excretion values. There is a wide range of urine GAGvalues in untreated MPS-I patients. A greater than 50% reduction inexcretion of undegraded GAGs following therapy with the conjugated agentis a valid means to measure an individual's response to therapy. Forexample, data is collected measuring the leukocyte iduronidase activityand buccal iduronidase activity before and after therapy in MPS Ipatients. Clinical assessment of liver and spleen size is performed asit is the most widely accepted means for evaluating successful bonemarrow transplant treatment in MPS-I patients (Hoogerbrugge et al.,Lancet 345:1398, 1995).

Example 9 Lysosomal Storage Diseases that May be Treated withCorresponding RAP-LE Conjugates

The diseases that can be treated or prevented using the methods of thepresent invention are: Mucopolysaccharidosis I (MPS I), MPS II, MPSIIIA, MPS IIIB, Metachromatic Leukodystrophy (MLD), Krabbe, Pompe,Ceroid Lipofuscinosis, Tay-Sachs, Niemann-Pick A and B, and otherlysosomal diseases. For each disease the conjugated agent would comprisea specific compound or enzyme. For methods involving MPS I, thepreferred compound or enzyme is α-L-iduronidase. For methods involvingMPS II, the preferred compound or enzyme iduronate-2-sulfatase. Formethods involving MPS IIIA, the preferred compound or enzyme is heparanN-sulfatase. For methods involving MPS IIIB, the preferred compound orenzyme is α-N-acetylglucosaminidase. For methods involving MetachromaticLeukodystropy (MLD), the preferred compound or enzyme is arylsulfataseA. For methods involving Krabbe, the preferred compound or enzyme isgalactosylceramidase. For methods involving Pompe, the preferredcompound or enzyme is acid α-glucosidase. For methods involving CLN, thepreferred compound or enzyme is tripeptidyl peptidase. For methodsinvolving Tay-Sachs, the preferred compound or enzyme is hexosaminidasealpha. For methods involving Niemann-Pick A and B the preferred compoundor enzyme is acid sphingomyelinase.

Example 10 Further Exemplification of Receptor Binding, Cell Uptake andLysosomal Delivery of Fusions of RAP and α-L-Iduronidase or Acid aGlucosidase

The present example provides additional data demonstrating the efficientLRP receptor binding, cell uptake and lysosomal delivery of therapeuticenzymes using RAP as a delivery vehicle.

Fusion expression constructs—The human RAP coding sequence, encompassingamino acids 35-353, was amplified from human liver cDNA using PfuTurbopolymerase (Stratagene) and the primers RAPF 5′-GCGATAGGATCCTACTCGCGGGAGAAGAACCAGCCCAAGCCGTCCCC GA-3′ (SEQ ID NO:12) and RAPR5′-GCGATAAACCGGTTTCTGC CTCGGCGCGAGCTCTGGAGATCCTGCCGGACAGGTCC T-3′ (SEQID NO:13). This fragment does not include sequence encoding either thesignal peptide or the HNEL ER retention signal. The 5′-RAP primerincorporates an in-frame BamHI site at the 5′ end. The 3′-RAP primeradds sequence encoding a six amino acid spacer (AEAETG; SEQ ID NO: 29)including an in-frame AgeI site at the 3′-end. The modified RAP sequencewas cloned into the vector pC3B as an in-frame fusion with either humanalpha-L-iduronidase (amino acids 27-652) or human alpha-glucosidase(amino acids 70-952). Both lysosomal enzyme sequences were 5′-modifiedto remove their signal peptides and to add an in-frame AgeI site. Theexpression vector is derived from pcDNA3.1 (+) (Invitrogen) and includesthe rabbit beta-actin IVS2, the rat preproinsulin transcript leadersequence and the first 18 amino acids (signal peptide) of humanmelanotransferrin ending with an in-frame BamHI site.

Plasmid vectors were linearized with AclI and transfected into CHO-K1LRP⁻ (CHOdL) using standard protocols. Clones were selected by limitingdilution in medium containing 800 μg/mL G418. Clones were screened forexpression using fluorescent monosaccharide substrates for therespective lysosomal enzymes. A clone expressing RAP-IDU (CHOdL-R17) anda clone expressing RAP-GAA (CHOdL-RG20) were selected for furtherstudies.

Expressions of fusions—CHOdL-R 7 and CHOdL-RG20 were cultured inT-flasks in a protein-free medium supplemented with 2.5% fetal bovineserum. Production was carried out in the absence of serum in pH, oxygenand temperature-controlled 3 L Applikon bioreactors. Cells were grown onCytopore 1 beads (Amersham) for the production phase. Microcarriers wereretained during perfusion using an internal settler (BiotechnologySolutions). Bioreactor perfusion rates were determined my monitoringresidual glucose.

Purification and specific activity of RAP fusions—RAP-IDU cell culturemedium was clarified by passage through a SartoPore 1.2 depth filter andthen for sterility by passage through a 0.2 μm PES membrane filter. Thesterile, clarified medium was pH adjusted and then sequentially resolvedon Heparin Sepharose CL-6B (Amersham), Phenyl Sepharose HP (Amersham),and SP Sepharose Fast Flow (Amersham). Enzymatically active fractionswere pooled, concentrated and, when necessary, buffer-exchanged for thenext step using a 50 kDa mini-TFF membrane (Vivascience). The finalbuffer was 10 mM Sodium Phosphate pH 5.8, 150 mM Sodium Chloride.RAP-GAA was purified with or without non-binding passage through DEAEFast Flow (Amersham). The RAP-GAA fusion was then sequentially resolvedon Heparin Sepharose CL-6B (Amersham) and Phenyl Sepharose HP(Amersham). In-process and final eluates were treated as described forRAP-IDU.

Enzyme activity assays—Enzyme activity was measured by the hydrolysis ofsmall fluorigenic monosaccharide substrates using 96-well plateadaptations of published methods. For RAP-IDU activity, the substrate4-methylumbelliferyl iduronide (4-MUI) was used at a concentration of2.5 mM. For RAP-GAA activity, the substrate4-methylumbelliferyl-alpha-D-glucoside was used at a concentration of5.4 mM. Activity units are defined as micromoles of substrate hydrolyzedper minute at 37° C.

Characterization of oligosaccharides by FACE—FACE analysis was performedessentially as described previously (Starr et al., J. Chromatogr. A.,720(1-2):295-321, 1996; Hague et al., Electrophoresis, 19(15):2612-20).Briefly, proteins were denatured and treated with N-glycanase to releaseN-linked oligosaccharides. Isolated oligosaccharides were thenfluorescently labeled with aminonaphthalene-6-sulfonate by reductiveamination and resolved on polyacrylamide gels with fluorescencedetection. Band identity was inferred by measuring mobility relative toknown standards. When necessary, oligosaccharide identities wereconfirmed by additional FACE analysis after digestion with specificexoglycosidases.

Characterization of sialylation by IEF—Purified fusions were treatedwith Clostridium perfringens neuraminidase (Sigma) in 50 mM SodiumAcetate buffer pH 5 at 37° C. for an hour. Treated samples and untreatedcontrols were analyzed by IEF on a pH 3-9 gradient gel (AmershamPhastgel System).

Degradation of fusions by lysosomal proteases in vitro—Lysosomalproteases Cathepsin B, D and L were purchased from Calbiochem,resuspended in 50 mM Sodium Acetate pH 5 and stored frozen. For thedigests, 0.5 μg of each fusion was incubated with 10 ng of an equimolarmixture of the cathepsins (approximately 300 μM final concentration foreach) in 100 mM Sodium Acetate, 100 mM Sodium Chloride, 0.5 mM DTT, pH4.5 for 1 hour at 37° C. Reactions were quenched with SDS-PAGEsample-loading buffer containing 2% SDS and heated for 5 minutes at 95°C. Samples were resolved on Nu-PAGE 4-12% Bis-Tris SDS-PAGE gels andstained with Coomassie blue.

Expression and purification of sLRP2—As previously described (Bu andRennke, J. Biol. Chem., 271(36):22218-24 1996).

Expression of human lysosomal enzymes—Human alpha-L-iduronidase(Aldurazyme) was a kind gift from BioMarin Pharmaceutical and GenzymeTherapeutics. Human lysosomal alpha-glucosidase was expressed andpurified using proprietary methods. The purified enzyme is greater than95% pure and carries at least one bis-phosphorylated oligomannosestructure per molecule of protein (based on FACE analysis and retentionon a mannose 6-phosphate receptor column, unpublished results).

Ligand blots—PVDF membranes (Millipore) were pre-wet in methanol andthen equilibrated in PBS (11.9 mM Sodium Phosphate, 137 mM SodiumChloride, 2.7 mM Potassium Chloride pH 7.4). Membranes were then mountedin a Bio-Rad dot blot apparatus. The second ligand-binding domain ofLRP1 (sLRP2, 1 μg/well) was applied to the membrane by vacuumfiltration. The membrane was then cut into sections that were placed inseparate wells of a 24-well plate. Membranes were blocked in TBS (20 mMTris pH 7.4, 150 mM Sodium Chloride) with 5 mM Calcium Chloride and 3%non-fat dry milk for 30 minutes. Ligands were incubated with eachmembrane spot for 2 hours at room temperature. Individual blots werewashed 2×5 minutes each with blocking buffer and then incubated withdifferent antibodies in block buffer for one hour at room temperature todetect binding.

Uptake into cell lines—Human fibroblasts were obtained from the CoriellCell Repository. Rat C6 glioblastoma cells and mouse C2C12 myoblastswere obtained from the American Type Culture Collection. Typically,uptake was performed in serum-free medium containing 20 mM HEPES pH 7.0and 0.5 mg/mL bovine serum albumin. Appropriate test proteins andinhibitors were diluted into the same medium and incubated with cellsfor various intervals. Cells were then rinsed with PBS, and trypsinized.Pellets were collected by low-speed centrifugation, washed with PBS, andlysed by freezing at −80° in the presence of 0.1% Triton X-100. Lysateswere clarified by centrifugation. The soluble lysate fractions wereassayed for enzyme activity and for total protein using the bicinchonicacid method.

Glycosaminoglycan clearance in human Hurlerfibroblasts mediated by theRAP-idu fusion—Human GM01391 Hurler fibroblasts were obtained from theCoriell Cell Repository and grown in DMEM 10% Fetal Bovine Serum and 2mM glutamine. Four days prior to the clearance experiment, cells wereseeded on 6-well plates at 250,000 cells per well. On the day of theexperiment, cells were fed with sulfate-free medium (S-MEM, IrvineScientific), 15% dialyzed Fetal Bovine Serum, 5 mM Calcium Chloride, 110mg/L Sodium Pyruvate for an hour and then the same with 4 μCi/mL35S-sodium sulfate and 5 nM of either RAP-idu or iduronidase alone.Cells were incubated in this medium for 48 hours at 37° C. in ahumidified cell-culture incubator with 5% CO₂/95% air. Cell layers wererinsed three times with PBS before and after trypsinization. Pelletswere lysed in 0.5N Sodium Hydroxide and neutralized with 1 MHydrochloric Acid. Protein concentrations were determined by BioRadProtein assay in 96-well plates. Lysate was counted in Beckman ReadyCaps.

Results

Expression and characterization of fusions—RAP fusions were configuredsuch that the RAP coding sequence was located N-terminally to thelysosomal enzyme coding sequence. The order of the sequences was basedon previously published studies demonstrating that GST-RAP fusions, inwhich RAP is located C-terminally to GST, had up to ten-fold loweraffinity for LRP than RAP alone Warshawsky et al., J Clin Invest 92,937-944, 1993). A CHO-K¹ mutant (CHOdL) was chosen for production of theRAP fusions (FitzGerald et al., J. Biol. Chem., 129, 1533-1541, 1995).CHOdL does not express any LRP receptors, preventing reuptake anddegradation of secreted protein by the over-expressing cell line.Fusions between RAP and both IDU (RAP-IDU) and GAA (RAP-GAA) wereexpressed in this system. Clones for each fusion were selected based onenzyme activity in the cell culture medium and scaled-up for productionin bioreactors. Volumetric productivity values were calculated fromactivity concentrations (U/L) and the specific activities (U/mg) ofpurified rhIDU or rhGAA. Calculated in this way, the average dailyreactor productivities were 1-2 mg/L-day for RAP-IDU and 10-15 mg/L-dayfor RAP-GAA.

Purification and characterization of fusions—Fusions were purifiedto >95% using conventional resins (FIG. 19A, lane 1). Anti-RAPantibodies (FIG. 19A, lane 2) and either anti-IDU or anti-GAA antibodies(FIG. 19A, lane 3) co-stained bands consistent with the molecularweights of each fusion on Western blots of conditioned cell culturemedium. While stable in conditioned medium, the fusions were observed tobe sensitive to proteolytic cleavage events during purification thatresulted in the removal of RAP from the N-terminus of both fusionproteins. Proteolysis was mitigated by addition of protease inhibitorsto the conditioned medium prior to purification.

Molar specific activities of the purified fusions were calculated bydividing enzyme activity concentrations (U/mL) by protein concentrations(nmol/mL) of the fusion. Fusion concentrations were calculated from A₂₈₀measurements and theoretical extinction coefficients (Table A).

TABLE A Physical parameters of RAP fusion proteins rhIDU RAP-IDU rhGAARAP-GAA Amino acids 627 952 883 1208 Apparent MW 83 kD 125 kD 110 kD 150kD (SDS-PAGE) Theoretical 70 kD 108 kD 98 kD 136 kD protein MWTheoretical 118280 154410 159890 196020 εM¹χμ¹ Activity 104 U/mL 7.4U/mL 6.2 U/mL 5.1 U/mL concentration Protein 8.3 nmol/mL 1.3 nmol/mL 21nmol/mL 16 nmol/mL concentration Molar specific 12.5 U/nmol 5.7 U/nmol0.29 U/nmol 0.32 U/nmol activity K_(m) (4-MUI) 0.3 mM 0.3 mM NA NAV_(max) (Units 1.65 1.22 NA NA at 24° C.) Bis-7 +++ + +++ −

RAP-IDU had a molar specific activity of 5.7 U/nmol, while rhIDU had amolar specific activity of 12.5 U/nmol. The substantial difference inmolar specific activities for RAP-IDU and rhIDU suggests that RAPinterferes in some way with the catalytic activity of IDU within thecontext of the fusion. The diminished activity of the fusion couldinvolve restriction of access to the active site, alterations in thefolding of IDU or other conformational constraints that affect proteinmotions involved in catalysis. In order to gain more insight into thecatalytic differences between rhIDU and RAP-IDU, kinetic parameters forcleavage of 4-MUI were measured (FIG. 19B). While the K_(m) values forthe two proteins were indistinguishable, the V_(max) for rhIDU exceededthat of RAP-IDU by 25%. This difference is consistent with someconstraint being imposed on the motion of IDU within the context of thefusion rather than restricted access to the active site. RAP-GAA andrhGAA were found to have nearly identical molar specific activities.

Digestion of RAP fusions with lysosomal proteases—To simulate thebehaviour of the fusions in the lysosome, preparations of RAP-IDU andRAP-GAA were incubated with a mixture of cathepsin D, B and L at pH 4.5at 37° C. for 1 hour. Digested proteins were analyzed by SDS-PAGE. RAPwas degraded under these conditions, leaving the lysosomal enzyme intact(FIG. 19C, lanes 2 and 5). The major band remaining for each of the twofusions was slightly larger than rhIDU and rhGAA. The additional massmay be an indication that some RAP or linker sequence remains aftertreatment. N-terminal sequencing and peptide mapping indicate thatcleavage occurs at multiple sites within the last 20 amino acids of RAPand the linker sequence. GAA activity per volume of digest was notsignificantly affected by in vitro proteolysis. This result isconsistent with the similar molar specific activities of RAP-GAA andrhGAA. IDU activity per volume of digest increased by 26% after in vitroproteolysis of the fusion, suggesting a partial restoration of theenzymatic activity of the released IDU moiety compared to rhIDU. Thespecific activity of fusion-derived IDU after delivery to the lysosomewas not determined.

Characterization of RAP fusion oligosaccharides—Given the important rolethat oligosaccharide receptors play in the uptake of lysosomal enzymesin vivo, the identity and types of oligosaccharides present on the RAPfusions was determined. First, purified fusions were subjected to FACEanalysis to measure levels of phosphorylated oligosaccharides relativeto the native lysosomal enzymes (FIG. 20A). Phosphorylatedoligosaccharides are readily identified by their characteristicmobilities on FACE gels. Both rhIDU and rhGAA possessed significantamounts of bis-phosphorylated oligomannose 7 (Bis-7), a structure thatis bound tightly by the MPR (Zhao et al., J Biol Chem 272, 22758-22765,1997; FIG. 20A, lane 2, arrow). Each oligosaccharide band wasquantitated by fluorescence intensity. Bis-7 accounted for 30 and 20% ofall oligosaccharides on rhIDU and rhGAA, respectively. In both cases,these percentages are consistent with 1-2 molecules of Bis-7 for eachmolecule of enzyme. While the rhIDU and RAP-IDU oligosaccharide profileswere otherwise similar, the fusion carried 60% less Bis-7 compared tothe enzyme alone (FIG. 20B, lane 3). This value equates to roughly onemolecule of Bis-7 for every three molecules of RAP-IDU fusion. The rhGAAand RAP-GAA oligosaccharide profiles were also similar (compare FIG.20A, lanes 2 and 3), but, in contrast to RAP-IDU, no phosphorylatedoligosaccharides were found in significant amounts on the RAP-GAAfusion.

To test for complex oligosaccharides terminating in sialic acid, theRAP-GAA fusion was subjected to IEF analysis after treatment withneuraminidase (FIG. 20B). A shift of the fusion to more basicisoelectric points provided evidence that RAP-GAA contained sialylatedcomplex oligosaccharide (compare FIG. 20B lanes 1 and 2). The positivecontrol, rhIDU, underwent a similar shift upon treatment withneuraminidase (compare FIG. 20B lanes 3 and 4).

The large size of the fusions made it difficult to analyzeoligosaccharide mass and content by digestion with glycosidases. Toreduce the size of the protein component, samples of RAP-IDU and RAP-GAAwere digested with cathepsins. Proteolyzed fusions were then furtherdigested with Endo H or N-glycanase to release high-mannoseoligosaccharides and total oligosaccharides, respectively. Thisexperiment does not address the oligosaccharide content of the RAPportion of the fusion since this is lost upon cathepsin proteolysis. RAPhas one glycosylation site. Endo H digestion of proteolyzed RAP-GAA hadlittle effect on band mobility, indicating minimal high-mannose orhybrid oligosaccharides on the GAA part of the fusion (FIG. 20C, comparelanes 3 and 4). Digestion of proteolyzed RAP-GAA with N-glycanaseresulted in a band shift of 17 kD. This result is consistent with theisoelectric focusing experiment in that both demonstrate high levels ofcomplex oligosaccharides on the RAP-GAA fusion. In contrast withRAP-GAA, Endo H digestion of proteolyzed RAP-IDU resulted in asignificant band-shift, consistent with the presence of high-mannose orhybrid oligosaccharides on fusion-derived IDU (compare FIG. 20C lanes 7and 8). The RAP-IDU sample used for this experiment was already partlyproteolyzed during purification. By mass, the loss upon digestion of IDUwith endo H accounted for the majority of the total loss observed upondigestion with N-glycanase (FIG. 20C lane 9).

Ligand blotting—Recombinant sLRP2, the entire second ligand-bindingdomain of human LRP1, was spotted onto nylon membrane filters (FIG. 21).After blocking, individual filters were incubated with RAP (column B),RAP-IDU (column C) or rhIDU (column D) in binding buffer. Filters werewashed and probed with anti-RAP (row 1) or anti-IDU antibodies (row 2).Judging by signal intensity, RAP-IDU bound to the receptor fragment aswell as RAP alone under these conditions (columns B and C, row 1).Binding of RAP and RAP-IDU could be blocked with excess cold RAP (columnC, row 3). Recombinant human IDU did not bind to sLRP2 (column D). Theseresults demonstrate that the RAP moiety within the RAP-IDU fusionretains the ability to specifically bind to LRP.

Uptake of RAP fusions into patient fibroblasts—To determine whether RAPfusions could be taken up into cells in culture, RAP-IDU, RAP-GAA, rhIDUor rhGAA were added to primary human fibroblasts isolated from eitherHurler (IDU-deficient, GM1391) or Pompe (GAA-deficient, GM244) patient.Test protein concentrations for the uptake experiments were calculatedfrom A₂₈₀ measurements and theoretical extinction coefficients.Following an interval of one to two hours to allow for uptake, cellswere harvested, lysed and assayed for lysosomal enzyme activity. Uptakesignal is reported in units of fluorescent substrate cleaved per volumeof lysate. Identical numbers of cells were used in each well andnormalizing the activity data to total protein in each sample did notchange the results. Curves were fitted to hyperbolic functions anduptake parameters derived using GraphFit (Erithacus Software). Thehyperbolic asymptote value is defined here as the maximum uptakecapacity. The concentration of fusion or enzyme giving half-maximaluptake is defined, as it has been previously, as K_(uptake) (Sando andNeufeld, Cell, 12(3):619-27, 1977).

Fibroblasts in culture were found to take up significantly more RAPfusion than enzyme alone (FIG. 22A, B and Table B). This differencebecame more pronounced at higher concentrations of fusion and enzyme. Inparticular, the maximum uptake capacity for the fusion in Hurlerfibroblasts exceeded that of the free enzyme by 43-fold in the case ofRAP-IDU despite a 25-fold K_(uptake) advantage for the rhIDU. Since thespecific activity of the RAP-IDU fusion is about half that of rhIDU,uptake of fusion may be underestimated in this experiment. The maximumuptake capacity for RAP-GAA in Pompe fibroblasts exceeded that of rhGAAby 70-fold despite a 25-fold K_(uptake) advantage for rhGAA (FIG. 22B).

TABLE B Ratios of fusion to enzyme uptake at equimolar concentrations indifferent cell lines Uptake ratio (fusion/enzyme) Fusion enzyme celltype 5 nM 50 nM saturation K_(uptake) RAP-IDU rhIDU fibroblast 7 27 4325 RAP-GAA rhGAA fibroblast 9 37 70 25 RAP-GAA rhGAA C6 glioma 8 RAP-GAArhGAA C2C12 18 myoblast

Inhibitors of LRP (RAP) and MPR (mannose 6-phosphate) systems wereincluded in the culture media to determine whether RAP-IDU and RAP-GAAuptake into fibroblasts was receptor-specific. Excess RAP significantlyinhibited uptake of RAP-IDU and RAP-GAA in fibroblasts (FIG. 22C andFIG. 22D). Conversely, excess mannose 6-phosphate had minimal effects onthe uptake of RAP-GAA into the same cells (FIG. 22D).

Similar experiments were then carried out using a brain cell line, ratC6 glioma cells (FIG. 22E) and a muscle cell line, mouse C2C12 myoblasts(FIG. 22F). At 5 nM concentrations, the uptake of RAP-GAA into C6 gliomacells was over 7-fold more efficient than rhGAA. Under the sameconditions, uptake of RAP-GAA was 18-fold more efficient than rhGAA inC2C12 myoblasts. As was the case in the fibroblasts, uptake of RAP-GAAinto either cell line was inhibited by RAP but not by mannose6-phosphate. These results show that fusions were efficientlyendocytosed by cells in culture and that endocytosis occurred via LRP.The relative efficiencies of uptake for the MPR and LRP systems likelydepend on the relative density of each receptor on each particular celltype.

Uptake of RAP-GAA by different LRP receptors—In order to determinewhether uptake could be mediated by specific LRP receptors, RAP-GAA wasradio-iodinated and incubated with a panel of recombinant CHOdL linesexpressing different LDLR family members. Brown Norway rat yolk-saccells (BN) were used as the test line for megalin. LRP1 and LRP1B wererepresented by mini-receptors comprising roughly the C-terminal third ofthe full-length proteins, which includes the fourth ligand-bindingdomain, capable of mediating high-affinity binding of RAP. Additionally,these mini-receptors possess intact cytoplasmic tails and have beenpreviously shown to faithfully reproduce the trafficking behavior of thefull-length receptors (Li et al., J. Biol. Chem., 276, 18000-18006,2001; Obermoeller-McCormick et al., J Cell Sci 114, 899-908, 2001).Uptake of the fusion was determined by measuring the appearance ofsoluble counts in the cell culture medium. Soluble counts havepreviously been demonstrated to reflect uptake, lysosomal delivery,degradation and release of labeled amino acids from the cells (Iadonatoet al., Biochem J 296 (Pt 3), 867-875, 1993). LRP receptor-specificuptake was calculated by subtracting signal obtained in the presence ofexcess cold RAP competitor (FIG. 23). RAP-GAA was specifically taken upand degraded by cells expressing megalin, LRP1, LRP1B, VLDLR and apoER2but not LDLR or cells containing empty vector. These findings areconsistent with the fact that LDLR binds to RAP with significantly loweraffinity when compared to other members of the LDLR family (K_(d)≈250nM, Medh et al., J Biol Chem 270, 536-540). This experiment confirmsthat the binding behavior of RAP is predictive of the binding behaviorof RAP fusions. Similarly, RAP-inhibitable production of soluble countsindicates that RAP-GAA is endocytosed and lysosomally targeted by thedifferent LRP receptors.

Intracellular half-life of RAP-GAA—To test the stability ofRAP-delivered lysosomal enzyme in the lysosome, RAP-GAA or rhGAA wasincubated with Pompe patient fibroblasts (GM244) in multi-well platesfor 24 hours, transferred them to growth medium lacking the testproteins and then harvested the cells over a period of two weeks. Celllysates were then assayed for GAA activity. Fusion-derived GAA and rhGAAhad nearly identical intracellular half-lives of approximately 12 and 10days, respectively (FIG. 24). Because GAA has a half-life at neutral pHthat is measured in hours, the nearly identical, multi-day half-lives ofrhGAA and fusion-derived GAA imply delivery of both to an acidiccompartment after endocytosis, most likely the lysosome. Delivery ofphosphorylated rhGAA to the lysosome is well-documented in theliterature and is the basis for ERT with rhGAA (Van der Ploeg et al., JClin Invest 87, 513-518, 1991; Yang et al., Pediatr Res 43, 374-380,1998). Any changes imposed upon GAA as a result of fusion to RAP do notseem to affect the stability of the enzyme in the lysosome.

Clearance of lysosomal storage with RAP-IDU—Given the attenuatedenzymatic activity of fusion-derived IDU in vitro, experiments were doneto determine whether RAP-IDU could prevent the accumulation ofglycosaminoglycan in patient fibroblasts. Hurler fibroblasts were grownin sulfate-free medium (S-MEM) in the presence of ³⁵S-sulfate (Bartonand Neufeld, J Biol Chem 246, 7773-7779, 1971). RAP-IDU, rhIDU or bufferwas included in the growth medium at a concentration of 5 nM. Thepurities of the RAP-IDU and rhIDU test materials were confirmed bySDS-PAGE (FIG. 25B (inset)). Stored ³⁵S-glycosaminoglycan was measured48 hours later and normalized to total protein concentration. Totalradioactivity per sample ranged from 4,000 to 20,000 cpm; total proteinconcentrations did not vary significantly between samples. Both RAP-IDUand IDU prevented ³⁵S-GAG storage to the same extent, indicating thatfusion-derived IDU is competent to digest the natural substrate.

Example 11 Megalin Mediates Transcytosis Across the Blood Brain Barrier

The present Example describes studies performed using tight monolayersof MDCK cells in Transwell plates as a model system for transcytosis.This model was employed to demonstrate that megalin rather than LRP1mediates transcytosis of RAP. MDCK cells had been transfected withmini-receptors consisting of the fourth ligand binding and transmembranedomains of LRP I with either the C-terminal cytoplasmic tail of LRP1(mLRP/LRPTmT=LRPt) or of megalin (mLRP/LRPTmMegT=MEGt). The system takesadvantage of the superior expression levels of these minireceptors aswell as the modularity of different LRP receptor domains. The premisesof the system are that the LRP1 ecto-domain and the megalin ecto-domainbind RAP similarly, and that megalin tail-mediated trafficking in MDCKis similar to that in other epithelial cell layers, including the braincapillary endothelium.

In Vitro Transport Assays

Stably transfected MDCK cells and the parent MDCK line were obtainedfrom Dr. Maria-Paz Marzolo (Santiago, Chile). LRPt is distributedbasolaterally as shown by indirect immunofluorescence with an anti-HAantibody, and MEGt localizes to the apical surface of the transfectedMDCK cells (Marzolo et al., Traffic, 4(4):273-88, 2003). Cells wereplated on the surface of polyacetate membrane inserts of the Transwellsystem (Costar, Cambridge, Mass.) with a uniform pore size of 0.4 μm.Cells were seeded at a density of 2×10⁵ cell/ml and cultured in DMEMsupplemented with 10% FBS with medium change every three days. Cellswere kept in a 5% CO₂ incubator at 37° C. Transcytosis studies wereperformed in triplicates of Transwells of six groups for eitherapical-to-basolateral or basolateral-to-apical transport, with orwithout inclusion of 2 μg/ml of excess unlabeled RAP.

Twenty minutes prior to the transport assay, the Transwell insert andits supporting endothelial cell monolayer were equilibrated in thetransport buffer (Hank's balanced salt solution with 25 mM HEPES and0.1% albumin) at 37° C. Transport was initiated by addition of ¹²⁵I-RAP(1 μCi/ml) and ^(99m)Tc-albumin (2 μCi/ml) to the upper or lowerchambers at time-zero. The plate was kept at 37° C. with gentle mixingat about 130 rpm during the entire procedure. At 5, 10, 15, 20, 30, 40,50, and 60 min, 10 μl of sample was collected in the lower chamber ofeach well. At 60 min, solution in the upper and lower chambers wastransferred to separate test tubes at 4° C. The radioactivity of ¹²⁵ I-and ^(99m)Tc-albumin was measured simultaneously in a gamma counter witha dual-channel program. The amount of intact ¹²⁵I-RAP and^(99m)Tc-albumin after transport was measured by acid precipitation.HPLC analysis was performed on selected samples, with a linear gradientof 10-90% acetonitrile in 0.1% trifluoroacetic acid over 40 min, and 1ml fractions were collected.

At the time of study, the TEER of the confluent monolayers, a parameterindicating of the tightness of the barrier, was 757 Ω/cm2 for nativeMDCK, 364 Ω/cm2 for LRPt-transfected MDCK, and 370 Ω/cm2 forMEGt-transfected MDCK.

The transcytosis assays were initiated by addition of ¹²⁵I-RAP and theparacellular permeability marker ^(99m)Tc-albumin simultaneously attime-zero. At the end of the study (60 minutes), intact ¹²⁵I-RAPaccounted for 99% of the acid precipitable radioactivity in the donorchamber and 91% of that in the acceptor chamber. This indicates that themajority of radioactivity measured represented intact ¹²⁵I-RAP.Extending the study period to 120 minutes did not change the percentageof intact ¹²⁵I-RAP or the flux rate.

For apical-to-basolateral flux, in non-transfected MDCK cells, thepermeability coefficient of ¹²⁵I-RAP after 60 min of transport was5.1±0.8×10⁻⁶ cm/sec. By contrast, in MDCK cells transfected with MEGt,the permeability coefficient of ¹²⁵I-RAP was 18.1±1.2×10⁻⁶ cm/sec.Surprisingly, in MDCK cells transfected with LRPt, there was nosignificant flux. In all groups, ^(99m)Tc-albumin also had nosignificant flux.

Addition of excess unlabeled RAP at 2 μg/ml significantly decreased thepermeability coefficient of ¹²⁵I-RAP in MEGt-transfected cells(6.3±0.4×10⁻⁶ cm/sec) [F(1,12)=86.1, p<0.0001]. Whereas thenon-transfected cells had no, significant flux after addition of excessRAP, the difference between the groups with and without excess RAP wasalso statistically significant [F(1,11)=24, p<0.0005]. Thus, the resultssupport the presence of a saturable transport system for RAP at theapical surface and the essential role of megalin in the transportprocess.

For basolateral-to-apical flux, the transport of ¹²⁵I-RAP in all threegroups was not significantly higher than that of ^(99m)Tc-albumin, themarker for paracellular permeability (FIG. 18). For MDCK cells stablytransfected with MEGt, the apical-to-basolateral permeabilitycoefficient of ¹²⁵I-RAP was 460 times higher than thebasolateral-to-apical permeability coefficient. Taken together, theseresults support megalin tail-mediated transcytosis of RAP.

All of the compositions and/or methods disclosed and claimed herein canbe made and executed without undue experimentation in light of thepresent disclosure. While the compositions and methods of this inventionhave been described in terms of preferred embodiments, it will beapparent to those of skill in the art that variations may be applied tothe compositions and/or methods and in the steps or in the sequence ofsteps of the method described herein without departing from the concept,spirit and scope of the invention. More specifically, it will beapparent that certain agents which are both chemically andphysiologically related may be substituted for the agents describedherein while the same or similar results would be achieved. All suchsimilar substitutes and modifications apparent to those skilled in theart are deemed to be within the spirit, scope and concept of theinvention as defined by the appended claims.

The references cited herein throughout, to the extent that they provideexemplary procedural or other details supplementary to those set forthherein, are all specifically incorporated herein by reference.

1. A compound comprising a megalin-binding moiety conjugated to an agentof interest.
 2. The compound of claim 1, wherein said agent is selectedfrom the group consisting of a therapeutic agent, a diagnostic agent, amarker of a disease of the central nervous system (CNS), a labeledmonoclonal antibody which binds a marker of a CNS disorder.
 3. Thecompound of claim 2, wherein said therapeutic agent is selected from thegroup consisting of a protein, a cytotoxic chemotherapeutic agent, aprotein nucleic acid, an siRNA molecule, an antisense molecule, and anexpression construct comprising a nucleic acid that encodes atherapeutic protein of interest.
 4. The compound of claim 1, whereinsaid megalin binding moiety and said agent of interest are directlylinked to each other.
 5. The compound of claim 1, wherein said megalinbinding moiety and said agent of interest are linked through a linker.6. The compound of claim 5, wherein said linker is a peptide linker. 7.The compound of claim 1, wherein said megalin binding moiety is a moietythat is transcytosed in vivo.
 8. The compound of claim 1, wherein saidmegalin binding moiety is selected from the group consisting of RAP,thyroglobulin, lipoprotein lipase, lactoferrin, apolipoproteinJ/clusterin, apolipoprotein B, apolipoprotein E, tissue type plasminogenactivator, uPA, PAI-1, vitamin D-binding protein, vitaminA/retinol-binding protein, β2-microglobin, α1-microglobulin, vitaminB12/cobalamin plasma carrier protein, transcobalamin (TC)-B12, PTH,insulin, EGF, prolactin, albumin, apo H, transthyretin, lysozyme,cytochrome-α,α-amylase, and Ca2+, and aprotinin.
 9. The compound ofclaim 8, wherein said megalin binding moiety is receptor associatedprotein.
 10. A chimeric molecule for transcytotic delivery into thebrain across the blood-brain barrier, said chimeric molecule comprisinga megalin ligand conjugated to an active agent to be delivered acrossthe blood-brain barrier by transcytosis, wherein said megalin ligandfacilitates transport of said chimeric molecule across the blood-brainbarrier.
 11. A chimeric molecule for delivery into the brain bytranscytosis across the blood-brain barrier, said chimeric moleculecomprising an LRP ligand conjugated to an active agent to be deliveredacross the blood-brain barrier by transcytosis, wherein said LRP ligandbinds preferentially to megalin as compared to LRP1.
 12. The compound ofany of claims 1 through 8, or the chimeric molecule of any of claims 10or 11, wherein said agent of interest is bound to the C-terminus of themegalin binding moiety.
 13. The compound of any of claims 1 through 8,or the chimeric molecule of any of claims 10 or 11, wherein saidmegalin-binding moiety and said agent of interest are each a protein andmegalin-binding moiety is bound to the N-terminus of the agent ofinterest.
 14. A pharmaceutical composition comprising a compound of anyof claims 1 through 8, or a chimeric molecule of any of claims 10 or 11in a pharmaceutically acceptable carrier, diluent or excipient.
 15. Apharmaceutical composition comprising a compound of claim 12 in apharmaceutically acceptable carrier, diluent or excipient.
 16. Apharmaceutical composition comprising a compound of claim 13 in apharmaceutically acceptable carrier, diluent or excipient.
 17. A methodof delivering an agent into the central nervous system of an animalcomprising administering said animal said agent conjugated to a megalinbinding moiety, wherein the transport of said agent conjugated to saidmegalin-binding moiety across the blood brain barrier of said animal isgreater than the transport of said agent in the absence of conjugationto said megalin binding moiety.
 18. A method of increasing transcytosisof an agent, comprising conjugating said agent to a megalin-bindingmoiety, wherein transcytosis of said agent when conjugated to saidmegalin-binding moiety is greater than the transcytosis of said agent inthe absence of said conjugation.
 19. A method of treating a disorder ina mammal comprising administering to said animal a therapeutic agentconjugated to a megalin binding moiety.
 20. The method of claim 19,wherein said disorder is a disorder of the CNS.
 21. The method of claim20, wherein said disorder is selected from the group consisting ofAlzheimer's Disease, Parkinson's Disease, Multiple Sclerosis,Amylotrophic Lateral Sclerosis, and a central nervous system cancer. 22.The method of claim 21, wherein said disorder is a central nervoussystem cancer and said agent is a cancer chemotherapeutic agent.
 23. Amethod of delivering a therapeutic enzyme to a lysosomal compartment ina cell expressing megalin, comprising contacting said cell with acomposition comprising said therapeutic enzyme conjugated to amegalin-binding moiety, wherein the uptake of said therapeutic enzymeinto the lysosomal compartment of said cell is mediated through megalinpresent on the surface of said cell.
 24. A method of treating alysosomal storage disease (LSD) in a subject comprising administering tosaid subject a composition comprising a megalin-binding moietyconjugated to a therapeutic agent used in the treatment of said LSD, inan amount effective to ameliorate the symptoms of said LSD.
 25. Themethod of claim 24, wherein said therapeutic agent is an enzymedeficient in said LSD.
 26. The method of claim 24, wherein said LSD isselected from the group consisting of lysosomal storage disease isselected from the group consisting of aspartylglucosaminuria,cholesterol ester storage disease, Wolman disease, cystinosis, Danondisease, Fabry disease, Farber lipogranulomatosis, Farber disease,fucosidosis, galactosialidosis types I/II, Gaucher disease typesI/II/III, Gaucher disease, globoid cell leukodystrophy, Krabbe disease,glycogen storage disease II, Pompe disease, GM1-gangliosidosis typesI/II/III, GM2-gangliosidosis type I, Tay Sachs disease,GM2-gangliosidosis type II, Sandhoff disease, GM2-gangliosidosis,α-mannosidosis types I/II, β-mannosidosis, metachromatic leukodystrophy,mucolipidosis type I, sialidosis types I/II mucolipidosis types II/IIII-cell disease, mucolipidosis type IIIC pseudo-Hurler polydystrophy,mucopolysaccharidosis type I, mucopolysaccharidosis type II, Huntersyndrome, mucopolysaccharidosis type IIIA, Sanfilippo syndrome,mucopolysaccharidosis type IIIB, mucopolysaccharidosis type IIIC,mucopolysaccharidosis type IIID, mucopolysaccharidosis type IVA, Morquiosyndrome, mucopolysaccharidosis type IVB Morquio syndrome,mucopolysaccharidosis type VI, mucopolysaccharidosis type VII, Slysyndrome, mucopolysaccharidosis type IX, multiple sulfatase deficiency,neuronal ceroid lipofuscinosis, CLN1 Batten disease, Niemann-Pickdisease types A/B, Niemann-Pick disease, Niemann-Pick disease type C1,Niemann-Pick disease type C2, pycnodysostosis, Schindler disease typesI/II, Schindler disease, and sialic acid storage disease.
 27. The methodof claim 25, wherein the agent is selected from the group consisting ofaspartylglucosaminidase, acid lipase, cysteine transporter, Lamp-2,α-galactosidase A, acid ceramidase, α-L-fucosidase, β-hexosaminidase A,GM2-activator deficiency, α-D-mannosidase, β-D-mannosidase,arylsulfatase A, saposin B, neuraminidase, α-N-acetylglucosaminidasephosphotransferase, phosphotransferase γ-subunit, L-iduronidase,iduronate-2-sulfatase, heparan-N-sulfatase, α-N-acetylglucosaminidase,acetylCoA:N-acetyltransferase, N-acetylglucosamine 6-sulfatase,galactose 6-sulfatase, β-galactosidase, N-acetylgalactosamine4-sulfatase, hyaluronoglucosaminidase, multiple sulfatases, palmitoylprotein thioesterase, tripeptidyl peptidase I, acid sphingomyelinase,cholesterol trafficking, cathepsin K, α-galactosidase B, and sialic acidtransporter.
 28. The method of claim 24, wherein said composition is apharmaceutical composition and is administered in an amount effective todecrease the amount of storage granules present in the brain tissue ofsaid mammal.
 29. The method of claim 24, wherein said administeringcomprises intrathecal administration into the central nervous system ofthe mammal.
 30. The method of claim 24, wherein said composition isadministered in an amount effective to decrease the amount of storagegranules present in the meningeal tissue of said mammal.
 31. The methodof claim 24, wherein said symptoms are monitored through routineassessment of history, physical examination, echocardiography,electrocardiography, magnetic resonance imaging, polysomnography,skeletal survey, range of motion measurements, corneal photographs, andskin biopsy.
 32. The method of claim 26, wherein the disease ismucopolysaccharidosis.
 33. The method of claim 32, wherein the diseaseis mucopolysaccharidosis I.
 34. The method of claim 24, wherein saidmammal with said lysosomal storage disease demonstrates about 50% orless of a normal α-L-iduronidase activity.
 35. The method of claim 28,wherein said pharmaceutical composition is administered at a dose ofbetween about 0.001 mg/kg body weight and 0.5 mg/kg body weight of saidhuman α-L-iduronidase administered weekly to a subject suffering from adeficiency thereof.
 36. The method of claim 28, wherein saidpharmaceutical composition is administered at a dose of between about0.01 mg/15 cc of CSF to about 5.0 mg/15 cc of CSF of the mammal of saidhuman α-L-iduronidase is administered weekly to a subject suffering froma deficiency thereof.
 37. The method of claim 24, wherein saidadministering of a megalin-binding moiety conjugated to a therapeuticagent results in normalization of developmental delay and regression insaid subject, reduction in high pressure hydrocephalus, reduction inspinal cord compression in said subject, and reduction in number and/orsize of perivascular cysts around the brain vessels of said subject. 38.The method of claim 29, wherein said intrathecal administrationcomprises introducing said pharmaceutical composition into a cerebralventricle.
 39. The method of claim 38, wherein said intrathecaladministration comprises introducing said pharmaceutical compositioninto the lumbar area or the cisterna magna.
 40. The method of claim 38,wherein said intrathecal administration is achieved by use of aninfusion pump.
 41. The method of claim 24, wherein said pharmaceuticalcomposition is intrathecally administered continually over a period ofat least several days.
 42. The method of claim 24, wherein the mammal isa human.
 43. The method of claim 25, wherein said method furthercomprises inducing antigen specific tolerance prior to the enzymereplacement therapy.
 44. The method of claim 43, wherein said antigenspecific tolerance comprises administration of an immunosuppressiveagent.
 45. The method of claim 44, wherein said immunosuppressive agentis cyclosporine A.
 46. The method of claim 44, wherein said antigenspecific tolerance further comprises administration of anantiproliferative agent.
 47. The method of claim 46, wherein theantiproliferative agent is selected from the group consisting of anucleotide analog or an anti-metabolite.
 48. The method of claim 46,wherein the antiproliferative agent is azathioprine.
 49. A method ofpromoting the breakdown of glycosaminoglycan (GAG) in a brain cell of asubject having lysosomal storage disease, said method comprisingadministering to said subject a pharmaceutical composition comprising anenzyme deficient in said lysosomal storage disease conjugated to amegalin-binding moiety in an amount effective to reduce the amount ofGAG present in said brain cell as compared to the amount of GAG presentin said cell prior to said administration.
 50. The method of claim 49,wherein said brain cell is a neuron.
 51. The method of claim 49, whereinsaid brain cell is a neuroglial cell.
 52. The method of claim 49,wherein said brain cell is an ependymal cell.
 53. The method of claim49, wherein said brain cell is a brain cell selected from at least oneof the group consisting of neurons, glial cells, microglial cells,astrocytes, oligodendroglial cells, perivascular cells, perithelialcells, meningeal cells, ependymal cells, arachnoid granulation cells,arachnoid membranes, dura mater, pia mater and choroid plexus cells. 54.The method of claim 53, wherein said brain cell is a meningeal cell. 55.The method of claim 49, wherein said subject has high pressurehydrocephalus and said administering reduces the amount of CSF fluid inthe meningeal tissue of said subject.
 56. The method of claim 49,wherein the number of lysosomal storage granules in said cell arereduced as compared to the number of lysosomal storage granules presentin a similar cell in the absence of administration of said conjugate.57. The method of claim 49, wherein the number of lysosomal storagegranules in said cell is reduced as compared to the number of lysosomalstorage granules present in a similar cell treated with enzyme alonewithout conjugation to said megalin-binding moiety.